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March 2, 2016

The A,B,C's about Dental Insurance

by Dr. Adam Koplon

One of the things we pride ourselves on at Koplon Implant & Family Dentistry is working with our patients and their insurance companies to make sure we develop an affordable treatment plan that is in line with their current dental insurance policies. We have patients come to our office all the time to meet with our talented Office Manager, Ronnie, to discuss options and insurance plans with him, so we asked Ronnie for some basic knowledge on dental insurance and helpful information you need to know.

Insurance can be complicated and varies by company to company, so while we share tips and information below, we always recommend you check directly with your insurance provider to ensure what you are covered for, fees, etc.

  • Our office participates in PPO (Preferred Provider Organization) with the majority of all insurance companies. Some of the insurance providers we work with include:
    • Blue Cross Blue Shield of Alabama
    • Delta Dental
    • Metlife
    • Southland
    • Cigna
    • United Concordia
    • United Health Care
  • Some insurance companies do not offer a PPO Plan.  They are generally referred to as an indemnity plan or a fee for service (FFS) with no set contract amount for procedures. This type of insurance pays based on zip codes and gives an average fee based on a specified mile radius.
  • If you are unsure if we accept your insurance, it’s always best that you contact your insurance company first, as your contract and plan is between you and them.
  • At Koplon Implant & Family Dentistry, we handle all aspects of filing your dental insurance as a courtesy to you, our patient.
    • We process all the appropriate documentation, should you have primary and secondary insurance.  Some patients are fortunate enough to have a third insurance, also known as Tertiary Insurance.
  •  Insurance companies give each covered family member a specified dollar amount each year.  The amounts generally range from $500 to $1500 per year, but you must find this out from your insurance company directly.
  •  Dental insurance is generally broken down into three tiers: 
    • Diagnostic/Preventive:
      • Cleanings
      • X-rays
      • Examinations
    • Basic Services:
      • Fillings
      • Extractions
      • Periodontics
      • Endodontics
    • Major Service
    • Crowns
    • Dentures
    • Partials
    • Bridges
  • Most insurance companies pay as follows, but we strongly encourage our patients to review their specific insurance policy to have an idea as to how their specific insurance company reimburses:
    • Diagnostic/Preventive: 100% 
    • Basic Services: 80% 
    • Major Services: 50%
  • A lot of times patients are under the impression that cleanings are a free service. Cleanings normally fall into the diagnostic/preventive category, however, the payment is deducted from your yearly maximum.
  • Individual dental insurance policies are offered by many insurance companies.  We always tell patients to keep in mind that most dental plans are purchased on an individual level and will have waiting periods in place for certain procedures.  Typically, there is a 6-month waiting period on basic services and a 12-month waiting period on major services. We strongly suggest when searching for individual plans to make this one of your top priority questions and get the facts straight from your provider.

Have any other questions about insurance that aren’t answered below? Feel free to email [email protected] to learn more!

For more information about flossing and maintaining good oral hygiene, call our office at 205-699-2551. We see patients from all over, including Leeds, Moody, Trussville, Pell City, Springville, Odenville, Sylacauga, Anniston, and beyond. Give us a call today! 205-699-2551. 

About Adam Koplon, D.M.D.

Dr. Adam is a certified member of the American Dental Association (ADA), the Academy of General Dentistry (AGD) and the American Institute of Implant Dentistry (AIID).
Read Dr. Koplon's Full Bio
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