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Understanding dental benefits

Understanding your dental insurance and how it works for you can be very confusing.  There are many different dental insurance providers (see above), but with a little effort, it is easy to gain a better understanding of your dental coverage. Please remember, Southwest Oral Surgery is happy to submit and/or check your dental benefits. However, it is ultimately the patient’s responsibility to understand and make sure they have dental coverage for their specific procedure.

Step 1.

First look at the following example of a medical vs a dental insurance card.  Most oral surgery services will not be covered by a medical insurance plan. You are looking for your dental insurance plan. Check out the example below.

Insurance Card

If we look at these 2 cards, hopefully the dental logo stands out on the card to the right. That is the dental insurance. The card on the left is a medical insurance card.  Note on the card to the left, there is no dental logo and the information displayed involves only office copays and prescription copays.

Step 2.

Now, you want to make note of your member ID number and your Group Number.  These numbers, as well as any effective date of coverage and insurance contact numbers will assist you when you check on your benefits. Check out the example below.

Insurance Card 2

In the above example make sure to locate the member/subscriber number, as well as the dental insurance logo (in this case delta dental) and any company contact information before moving to the next step.

Step 3.

Take a few minutes and call your dental carrier. When you are connected with a live attendant feel free to utilize some of the following questions to help guide your discussion with the agent.

  1. Do I have Oral Surgery coverage?
  2. What is my plan’s maximum dental coverage and are there benefits remaining?
  3. Is there coverage for impacted third molar surgery / dental implants (if applicable)
  4. If you are planning on being asleep for you procedure ask if General Anesthesia is a covered benefit.
  5. Does my plan require a medical denial prior to the dental insurance paying on the claim?
  6. Is my plan a PPO or HMO. Note, Southwest Oral Surgery does not participate in any HMO (Health Maintenance Organization) plans.
  7. Is Southwest Oral Surgery in network with your plan?

Step 4.

Take good notes and make sure to ask for the insurance attendants name and direct contact number in case any discrepancies arise.

Congratulations, you are well on your way to understanding your dental insurance coverage. Southwest Oral Surgery and Dental Implants thanks you for taking the time to learn about your insurance. We look forward to caring for you soon!