
May
Understanding what’s covered by your dental insurance is an important part of making sure you get the best oral care possible.
Here are some common questions that arise when people want to understand their cover better.
– If the treatment my dentist recommends is not covered by my insurance, does that mean it’s not necessary?
Some plans make exclusions such as sealants, pre-existing conditions, adult orthodontics, and specialist referrals. This depends on your dental plan, and you should not let the level of coverage determine whether you need treatment.
Some plans will only cover the least expensive solution, but it may not be the best option for your needs. It would be best if you decided based on your health needs and not on your insurance coverage.
Some plans provide cover based on a “customary fee” for each procedure. So, if your dentist’s fee is higher, your benefit will be based on a percentage of the customary fee instead of your dentist’s fee. Although these limits are called “customary,” they may not accurately reflect the fees that dentists charge in your area.
If your employer offers more than one plan, check the exclusions and limitations of the coverage, as well as look at the general benefits. It’s a good idea to discuss your family’s likely needs with your dentist before choosing a plan.
The plan document should specify who is eligible for coverage under the plan.
Plans offered by the same provider or employer can vary according to the contracts involved, so your dentist will not be able to answer specific questions about your benefit or predict what the coverage for a particular procedure will be.
If you have specific questions about coverage, talk to your plan and provide
Angelica P. Summer, DPD, has been a Licensed Denturist in Seattle, Washington, since 1996. She has owned and operated A Dental and Denture in North Seattle since 1999. She completed her education at the University of the East and specializes in creating all types of dentures while you wait. Angelica is an active member of the Washington Denturist Association, National Denturist Association, and International Federation of Denturists.
Isabella Amar, DDS, graduated with a Bachelor of Arts in Biochemistry, Chemistry, and Math from the University of Washington and completed her doctorate from the UW School of Dentistry. During her academic career, she won Outstanding Scholastic Achievement and
Omicron Kappa Upsilon National Dental Honor Society recognitions. Her approach to dental care is to provide the most optimal quality of treatment, creating a gentle experience and comfortable environment by forming personal connections with her patients and following up to ensure long-lasting results. She is also fluent in Mandarin and Cantonese.
Fawaz Hatem, BDS, MSD, is an Oral Medicine Specialist with over 20 years of experience. He completed his Bachelor of Dental Surgery in Baghdad, Iraq, and obtained a Master’s degree from the UW School of Dentistry and further training from the University of Southern California, Los Angeles. Dr. Hatem has specialized training in Invisalign orthodontic treatment, sleep dentistry, teeth whitening, and administering Botox and dermal filler injections to enhance facial aesthetics and relieve TMJ symptoms. He is proficient in Arabic and English.
Dental Implant Specialist Kevin La, DDS, received his doctorate from UCLA School of Dentistry and his postgraduate qualification – an AEGD certificate – from the UPenn School of Dental Medicine. He is an Associate Fellow of the American Academy of Implant Dentistry and is now a mentor for Associate Fellow Candidates. He is also a Fellow of the International Congress of Oral Implantology and a Diplomate of the American Board of Oral Implantology/ Implant Dentistry. The latter designation is the highest level of competence in implant dentistry. Dr. La serves as a mentor in study clubs and implant training courses. He is now in the teaching faculty at the Pacific Implant Academy (PIA) and co-director for the PIA Implant Live Surgery Course in Tijuana, Mexico.
All providers have years of experience and expertise in their respective areas and are focused on continuing education to provide the best services for their patients. They aim to bring beautiful, healthy smiles to everyone in Seattle, WA.