Navigating the complex world of dental insurance can feel like traversing a maze without a map, leaving many patients uncertain about how to fully leverage their benefits. For those with insurance, understanding the nuances of coverage, from preventive care to major procedures, can make the difference between paying substantial out-of-pocket costs and optimizing your dental healthcare dollars. The confusing terminology, varying coverage levels, and unclear network distinctions often leave patients wondering if they’re making the most financially savvy decisions for their oral health.
At White Pine Family Dental, we recognize that insurance confusion shouldn’t stand in the way of receiving quality dental care from the provider of your choice. Many patients mistakenly believe they can only visit in-network dentists, potentially sacrificing the personalized care, convenient location, or trusted relationship they’ve established with their preferred dental practice. We’re committed to helping our patients understand that being out-of-network with Delta Dental doesn’t mean your benefits are inaccessible; in fact, with the right knowledge, you can still receive significant coverage while maintaining your freedom to choose the dental care that best meets your needs.
Understanding In-Network vs. Out-of-Network Providers
Many patients assume they can only use their dental insurance with in-network providers. However, this is a common misconception that could prevent you from receiving care from the dentist of your choice. When a dental practice is “in-network,” they have a contractual agreement with an insurance company to accept certain rates for services. Being “out-of-network” simply means the dentist hasn’t signed that contract, but patients with Delta Dental can still use their benefits at our practice.
The key points between being in-network and out-of-network generally involve the following:
- You maintain the freedom to choose the dental provider you prefer
- Your annual maximum and deductible still apply the same way
- The insurance claim will be submitted for payment of the services rendered the same
- The Insurance may reimburse you for the services so you may need to pay the full amount at the time of service and receive reimbursement in a couple weeks.
- Out-of-pocket costs may be slightly higher with out-of-network providers
If you have further questions regarding being an in-network or out-of-network patient, contact our dental team today!
How to Maximize Your Delta Dental Benefits
If you have dental coverage through Delta Dental, it is important you understand how to maximize those benefits! Some ways you can maximize your benefits include the following:
Understand Your Coverage Details
Take time to review your specific Delta Dental plan. Different plans have varying levels of coverage for preventive, basic, and major services. Most plans cover:
- 100% of preventive care (exams, cleanings, x-rays)
- 80% of basic procedures (fillings, extractions, root canals)
- 50% of major procedures (crowns, bridges)
It is important to understand exactly what coverage you have with your personal plan.
Take Advantage of Preventive Benefits
Most Delta Dental plans cover preventive care at 100% every 6 months. Regular check-ups and cleanings help prevent more serious and costly dental issues down the road. Schedule your semi-annual appointments even if you don’t have any dental concerns.
Use Your Annual Maximum
If you have outstanding dental needs and available benefits remaining in your annual maximum, consider scheduling those treatments before your benefit period ends, typically December 31st. Unused benefits do not roll over to the next year with most plans.
Coordinate Major Treatments
For extensive treatments that exceed your annual maximum, we may be able to prioritize to take advantage of the benefit renewal the following year. This strategic scheduling can help maximize your coverage and minimize out-of-pocket costs.
Consider Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs)
If you have access to an FSA or HSA, use these tax-advantaged accounts to pay for dental expenses not covered by your insurance. This can significantly reduce the financial impact of out-of-pocket costs.
Why Choose White Pine Family Dental as Your Out-of-Network Provider
Being out-of-network doesn’t mean your Delta Dental benefits won’t help with your treatment costs. We work with many Delta Dental patients who enjoy significant coverage for their treatment at our practice. At White Pine Family Dental, we focus on providing exceptional dental care that puts your needs first. We take the time to thoroughly explain treatment options and help you understand how your insurance benefits apply to your care.Our team is experienced in working with insurance providers and can help you navigate the claims process. We strive to make dental care accessible and affordable for all our patients, regardless of network status. Don’t let insurance limitations restrict your choice of dental provider. Contact our office at (775) 825-6655 or through our contact form to learn more about how we can help you maximize your Delta Dental benefits while receiving the quality dental care you deserve.