Understanding Dental Coverage

The best way to take full advantage of your dental coverage is to understand all of its features. At ASK Dental Group, your West Los Angeles (Westwood) dental office we try our best to inform and educate you on your dental benefits.

Plan Basics

1. Almost all insurance companies offer a wide variety of benefit plans with different features. You may have friends or family members who are covered by the same insurance company, but their coverage differ from yours.
2. At ASK Dental Group, we “participate” in the all PPO Dental Plan Networks. This means that will submit your claim on your behalf and you have nothing to worry about. If you were to visit a dentist that did not participate, you may be responsible for paying your dentist and submitting your claim to your insurance carrier.
3. Dental benefits for dependents vary from plan to plan. Here at ASK Dental Group we pay attention to this matter and will inform you about specific information based on your specific plan.
4. Dental benefits are calculated within a “benefit period”, which is normally for one year but not always “Calendar Year”. It is important to know these dates.

Key Concepts

Maximums

Majority of dental plans have yearly maximum amounts. This means that the insurance company will pay up to a certain dollar amount within a specific benefit year (usually January through December) and at times (One year from the date you activated your dental plan). Consult us at ASK Dental Group, your West Los Angeles Dental Office for more information in regards to your yearly Maximum amounts.

Deductibles

Most dental plans have a specific dollar deductible. This deductible has a range and varies from plan to plan. It is similar to your car insurance. You personally have to pay a portion of your dental bill before you benefit kicks in and picks up the rest of the bill. Luckily this number is much lower for dental plans than it is for medical plans.

Coinsurance

Majority of dental insurances have a policy called “Coinsurance”. Meaning your policy pays a predetermined percentage of the cost of your treatment, and you are personally responsible for the balance. Your portion of this payment is called coinsurance and it is considered a part of your out-of-pocket cost. If your plan has a coinsurance you will be notified by our staff at ASK Dental Group. We will inform you all of your plan benefits and limitations.

Reimbursement Levels

Almost all dental plans in the United States offer 3 different classes or categories of coverage for dental treatment. At ASK Dental Group we will go over these levels with you so that you can understand what makes up each category. Reimbursement levels vary from plan to plan.

Here is the way the three levels typically work:

• Class I or Category 1  This includes most diagnostic and preventive care such as exams, xrays and regular cleaning and are covered at the highest percentage up to 100%. This is like a financial incentive from the dental insurance company for you the insured to seek early and preventive care. Here at ASK Dental Group, we believe preventive care is one of the most important aspect of oral health.
• Class II or Category 2  This includes most basic procedures — such as fillings, extractions and periodontal treatment and are covered at a slightly lower percentage. You should consult your west los angeles dentist to see what these limitations are.
• Class III or Category 3 is for most major services and is usually reimbursed at a lower percentage. This class of procedures may have a waiting period if you recently purchased your dental insurance as an individual. Normally these waiting periods are waived if you purchased these plans through an employer or during an Open Enrollment period. However a consultation with one of our treatment coordinators at ASK Dental Group will clarify these questions for you.

You may send us a request with your specific plan information such as group# and plan name and we will be happy to help you with any questions you might have. At ASK Dental Group, our goal is to make your dental visit easy and pain-free.