Here’s a useful analogy to help you understand how your dental insurance works.
Imagine you’re enjoying a peaceful afternoon at home when a pipe bursts in your home and water starts leaking from your ceiling. You call a plumber and ask that they come out as soon as possible; your next call is to your home insurance company.
You review your policy with an insurance representative who tells you that, based on your plan and situation, they will cover up to $500 in repair costs. The insurance company recommends a plumber in your area that they regularly work with who may be able to save you money. But you’ve already called a plumber of your choosing, referred by a friend.
Your plumber arrives, examines the pipe and gives you a repair estimate of $520. You could get another quote from the insurance company’s plumber, but instead you agree to have your plumber do the work. When it’s all said and done, you spent 20 dollars out of pocket. Maybe you could have saved with the insurance company’s plumber, but hey –your pipe is repaired. You can return to enjoying your afternoon.
When it comes to home and car repairs, most of us follow this pattern and understand what it is we’re paying for. The repair amount your insurance covered didn’t change, but the amount you paid out of pocket changed based on the plumber you chose. The same is true for your dental insurance.
An in-network dentist is the equivalent to the recommended plumber. Both are well qualified professionals. The difference is one has agreed to a fixed rate of service and the other hasn’t. PPO insurance plans will pay the designated amount for covered services. Your choice to go in-network or out-of-network will determine if and how much you pay out of pocket for that service.
Analogies aside, you may wonder what your dental insurance policy will and won’t cover, and how much will have to come out of your pocket. A good rule of thumb is that if you are having a procedure that you expect will cost $300 or more, you should get a pre-treatment estimate from your dentist. This will help you better understand your expected out-of-pocket costs, and gives you an opportunity to save or get a second opinion.
If you have a question or feel uncertain about what you will owe, it’s always a good idea to call your insurance carrier’s customer service line and ask them to walk you through the process.