Nov 20, 2013
This week we will continue our dental insurance tips by explaining the different levels into which dental procedures are divided. To make sure you get the most out of your coverage, make sure you know the procedure you are receiving and where it belongs in the levels of service. We will be walking you through examples of each level and giving you examples of coverage breakdowns. Of course, every insurance has different breakdowns, so check with your insurance company to find out exactly how you are covered.
The three main levels of service are preventative, basic, and major.
The coverage breakdown is, on average; 90-100% for preventative services, 80% for basic services, and 50% for major services. These percentages are of the insurance company’s usual and customary fees, not necessarily the office’s fees. If you visit an out-of-network provider, you will be responsible for the difference between what the insurance covers and what the office charges. The percentages provided here are just averages, contact your insurance company to find out your coverage breakdown.
If you ever have any questions as to how a service is going to be covered, we can send out a pre-treatment estimate to your insurance company. Or for a quicker response, you can call them directly and ask them. At Stephens Dentistry, we are happy to provide you with the ADA code that they will need to give you an estimate over the phone. Some insurance companies have automated their frequency limitation information, so you can find out how often you can have a procedure done without having to wait on hold.
The post Preventative vs. Basic vs. Major appeared first on Stephens Dentistry.
©2022 Stephens Dentistry. All Rights Reserved.