Many private insurance providers end up not covering as much of your treatment as you thought. As a result, patients are left to pay more out-of-pocket than expected. Insurance companies benefit the most from enrolling patients and denying or changing their benefits. This means that you can experience larger premiums each year, larger co-pays and deductibles, less coverage, and fewer reimbursements.

Because of how insurance companies work, it can be difficult to know exactly what we are getting from each policy, and it can be difficult to compare the benefits between different insurance providers. When it comes to your oral health, there are times when your dental insurance is the best choice and other times when your medical insurance is the best. For example, many health insurance companies will cover treatments for TMD, facial pain, headaches, and sleep apnea/snoring, whereas dental insurance will not. At Chetan Parikh, DMD, MDS, and DABCDSM, we can bill both your medical and dental insurance providers.

If you have an insurance provider who is not in-network with our practice, your out-of-pocket cost will be a little higher, but your insurance provider can still reimburse you for a portion of your treatment cost.

Your insurance coverage is often determined by your employer. This could mean that other patients with the same insurance provider but a different employer could have different benefits than you. Because of the various ways that patients can receive benefits, it can be difficult to advise patients on their precise plans and coverage. To understand your benefits more fully, we recommend talking with your insurance provider.

When using insurance to pay for your dental care, please keep the following in mind:

• For select patients, their dental insurance may provide benefits that we bill directly when it is best for the patient.
• Within the last 10 to 20 years, Medicare has stopped paying for dental treatments. However, they will still pay for initial exams and X-rays.
• If you have an HMO insurance plan, you will need a referral from your PCP before visiting the dentist for the first time. Generally, HMO plans pay for both the examination and the treatment.
• PPO insurance plans do not require a referral before visiting the dentist. These plans begin covering your treatment plan only after you have paid your full deductible.

Most dental practices are limited in their ability to access and utilize all of your medical insurance benefits. This is because the dental office either does not bill medical insurances, or they are not a listed provider for your medical insurance. This often leads to patients who have to pay for their treatment themselves, even though they have insurance coverage.

To fully understand your benefits and to know whether your medical insurance will cover your dental treatment, we recommend that you talk with your insurance provider directly.

If paid in full, in advance with cash or check you can receive up to 5% courtesy credit on your estimated out of pocket expense. CareCredit is a third-party financing company that offers low- and no-interest payment plans. For more information, and to schedule an appointment with our dentist in Rockville, Maryland, contact our office today.

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