Sorting out your family’s dental insurance can be a confusing and frustrating experience that leaves you with countless questions. What services can I expect to be fully or partially covered? What will I need to be prepared to pay out of my own pocket? How do I know which dentists in the Victoria, TX area take my specific plan?
At Victoria Pediatric Dental & Orthodontics, our team is proud to be an in-network provider for virtually all PPO insurance coverage. When you bring your child in for a visit, you can look forward to working with one of our insurance experts who knows how to navigate every in and out of your specific coverage. We look forward to helping families devise a treatment plan that is both revitalizing and affordable! Please contact us today if you’d like more information.
How early should I bring my teen in for an orthodontic consuWhat Kinds of Services Does Dental Insurance Cover?lt?
Dental insurance is designed to emphasize preventive care above all else. By providing full or significant coverage for checkups, cleanings, and other essential services, these plans can help children receive treatment for damage or decay very early on and avoid potentially serious dental problems down the road. Our doctors believe in the power of prevention too, and they do their best to assist families in maintaining optimal care for growing smiles both here in the office and at home with oral hygiene routines.
On the other side, medical insurance is less focused on preventing health problems. Instead, these financial resources are mostly allocated towards covering the serious cost that patients can incur when experiencing a chronic illness or traumatic injury. This is why families can expect to pay more on average for medical insurance when compared with dental insurance.
What Kinds of Services Does Dental Insurance Cover?
Every dental insurance plan is unique. In fact, coverage from one provider can even be separated into several different tiers! While parents should never assume that a specific treatment option will be paid for before going over the details of their coverage, there are some general guidelines that virtually every plan includes. For instance, preventive care is typically always covered at 100%, and many important restorative services (such as fillings, root canals, and crowns) receive partial benefits as well – anywhere from 80% to 50% of the cost covered, in most cases.
Parents should keep in mind that most dental insurance plans will have a yearly cap on the benefits they provide. This cap typically falls somewhere around $1500 and will reset once January 1st rolls around. However, you may be able to raise this number if you pay a higher premium.
In-Network VS Out of Network Insurance Coverage
Before settling on a dental insurance provider, it’s important that you understand the difference between in-network and out of network coverage. Most PPO insurance providers allow patients to choose their own dentists, but that doesn’t necessarily mean you’ll receive the same coverage from every dental office. Dental insurance benefits typically cover a percentage of specific preventive and restorative dentistry services. In-network providers have agreed to charge fees for service that the insurance plan deems fair and average. Out of network dental practices are able to charge higher prices for dentistry services, but your provider will still only cover their percentage of the fees for service they deem fair and average. You’ll be responsible for your percentage of the treatment cost as well as the difference in price. By visiting an in-network dentist, you know you’ll receive the highest percentage of coverage for your treatments.
What are Some of the Indications That My Teen Needs BraceWhich Dental Insurance Plans Does Your Practice Accept?s?
Both traditional braces and clear/ceramic orthodontics are capable of addressing dental problems like:
As we’ve already said above, Victoria Pediatric Dental & Orthodontics is happy to accept basically any PPO insurance plan. We work with several major providers, including the following:
- Delta Dental – Delta Dental is currently the largest dental insurance provider in the entire United States, covering more Americans than any other company. They’ve been in business since 1954 and assist patients of all ages in improving their oral health through plans that are affordable and accessible to families, individuals, and even employers.
- MetLife – MetLife is dedicated to helping people and families maintain healthy, happy smiles while also being able to successfully balance any out-of-pocket costs. They offer a wide variety of different plans so that you can select the one that fits your dental needs best. Plus, employers can secure insurance at a group rate and patients can choose flexible insurance that will be able to follow them even after they’ve switched jobs.
- Guardian – For over a century, Guardian has been a well-known name in health insurance. On average, they’re able to save their customers an average of 36% on their needed dental services! Today, they have around 114,000 dentists who are in-network with their plans and over 7 million current members, which proves that they hold themselves to impressively high standards.
- Overcrowded teeth: This issue makes brushing and flossing teeth very difficult and, in some cases, nearly impossible. Cavities are more likely to develop with overcrowding.
- Various bite problems (crossbite, underbite, overbite, openbite): Jaw alignment issues can cause TMJ pain, neck pain, and headaches. If you or your teenager are suffering from any of these issues, we can help.
- Significant gaps between teeth: This condition also makes cleaning your teeth difficult, can alter your speech patterns, and make it hard to chew.
- Vertically misaligned teeth: In some cases, teeth are out of line or set too far up in the gum. This is a more complex issue to deal with, but our orthodontist in Victoria, TX has the training and experience needed to correct it.
Your Medicaid Benefits
If you or a member of your family take advantage of Medicaid insurance coverage, the Victoria Pediatric Dentistry & Orthodontics team would be happy to help you maximize your Medicaid coverage. Our team regularly processes and files claims for patients with Medicaid, so we know how to maximize these benefits. If you have questions about your Medicaid coverage, please don’t hesitate to ask our team. We are always happy to help our patients better understand how Medicaid covers preventive and restorative dentistry services for our patients. We know that Medicaid plans can be complicated, so let our team demystify the Medicaid dental insurance process for you.
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