Insurance FAQ

DENTAL INSURANCE FREQUENTLY ASKED QUESTIONS

Dental insurance isn’t meant to cover the cost of dental treatment, it is meant to be a supplemental plan. Insurances have you pay a portion until you reach a certain amount, then they kick in and pay the rest after that point. Dental insurances, help cover the cost up to a point (usually $1500/year) and then they don’t pay any more.

Can I come to your office if you are not a preferred provider?

We accept payments from all dental insurances. The payment options and coverages vary greatly within the same company. At Snoqualmie Falls Dental we contact your insurance company for you and get your coverage information. We take this information and help you understand your insurance coverage and the patient responsibility costs for your various treatment options. We don’t do any treatment until you fully understand your individual insurance situation.

What is a PPO? (Preferred Provider Organization)

A PPO is a dental insurance plan that allows you to see any dentist that you want. You may receive different benefits depending on if you see an In-network dentist or an Out-of network dentist. Snoqualmie Falls Dental is a preferred provider for Premera, Regence and Washington Dental Service Premier and PPO. Snoqualmie Falls Dental can bill any other PPO insurance on your behalf.

Why won’t my insurance company pay for the treatment that my dentist recommends?

Snoqualmie Falls Dental is going to recommend the BEST treatment for you, based on their diagnosis and discussion with you. Your insurance company is going to pay for the LEAST costly treatment for them regardless of what is appropriate for your individual needs. Snoqualmie Falls Dental believes that insurance shouldn’t dictate treatment. Insurance is only one tool that patients can use to aid them in maintaining their dental health.

Why does my dental plan say it covers cleanings at 100% but my dentist sent me a bill?

If you see an out of network dentist and your insurance company pays 100% of UCR, you may receive a bill from your dentist. UCR means usual, customary and reasonable. This is a fee set by the insurance company and your employer and not a true reflection of fees in your area. If there is a difference between the UCR fee and your dentist’s fee, then you are responsible for the difference. Currently, there is a wide fluctuation between UCR’s of different insurance companies and different plans within each company. This does not mean that your dentist charges too much.

What does double insurance coverage mean?

If you have dental insurance through your employer and your spouse has dental coverage for you through their employer, then you have double insurance coverage. Your insurance is considered the primary insurance and your spouse’s is considered the secondary. If your secondary has a standard clause, they will pick up a percentage of what the primary doesn’t. If your secondary has a non-dual clause, they will not pick up anything left over from the primary.

What is a pre-determination?

A pre-determination is a claim sent to your insurance company telling them what treatment needs to be done. Your insurance then sends back a list of what they would cover for those services. A pre-determination is a great tool to help you and your dentist estimate fees but it is NOT a guarantee of payment and should only be used as a guidelines. Insurance companies will NEVER guarantee payment.

 

What is a DMO? (Dental Maintenance Organization)

A DMO is a dental insurance plan that requires the subscriber to sign up for a contracted dentist at the time of enrollment. This dentist must direct all of your dental care. If you don’t see this dentist, your insurance will not pay. Snoqualmie Falls Dental is not a DMO provider for any plans.

Snoqualmie Falls Dental is happy to help you understand your dental insurance. We will submit claims on your behalf and help you understand and maximize your dental benefits. Should the need arise, we will assist you with the appeals process. Please feel free to call our office and discuss these or any other insurance questions that you may have. 425-831-1790

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