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Maximizing Your Dental Insurance in the New Year



HAPPY 2024! For many of our patients, their dental insurance plans renew on January 1, which means annual annual maximums, deductibles, and covered procedures may reset for the new year. As your South San Francisco dentists, we want our patients to take advantage of their renewed insurance benefits and schedule any necessary dental procedures.


If you have any questions about your coverage or what procedures may be covered, we are happy to help you check your insurance benefits and see what treatments you've yet to complete. We want to be a resource for our patients and we understand how complicated insurance can be. Check out our quick-guide below to familiarize yourself with your dental insurance.


New Dental Resolutions For the New Year

In addition to utilizing your insurance benefits, the start of a new year is also a great time to make resolutions for your dental health. Whether this includes committing to brushing twice daily, scheduling regular dental cleanings or making dietary changes for improved teeth and gum health, we are here to support you in your journey to optimal dental health.


Schedule Your Next Visit

Has it been more than six months since your last visit to the dental office? If so, we highly recommend scheduling an appointment. We understand it's easy to avoid dental treatment -- many patients wait until they need to see us before they want to, and we don't want you to wait until then! Regular check-ups and cleanings are an important part of maintaining good oral health and catching any potential issues early on. Plus, it's a great opportunity to ask any questions or address any concerns you may have about your dental health.


Understanding Dental Insurance

We’ve put together this guide on how we handle your dental insurance so you know what to expect from us, and make sure your insurance benefits are working for you. Our mission at South San Francisco Dental Care is to provide excellent dental care by combining the best of modern technology with unparalleled customer service. Dental insurance can be quite complex -- by working with your insurance company, we aim to take away some of the stress and confusion so you don’t have to deal with it.


As a complimentary service to you, we will:

  • Check your insurance benefits

  • Estimate your insurance coverage

  • Submit claims on your behalf


We are aware dental insurance terminology can be confusing. Delta Dental has an excellent glossary, and we’ve copied the most common terms you’ll likely hear us use when we go over your benefits:


  • Copayment A fixed dollar amount that you are required to pay at the time the service is rendered.

  • Deductible A dollar amount that you (or your family, if it’s a joint account) must pay for certain covered services before your insurance begins paying benefits

  • Preauthorization A requirement that recommended treatment must first be approved by your insurance company before the treatment is rendered in order for the plan to pay benefits for those services.

  • Out-of-pocket costs Any amount you are responsible for paying, such as coinsurance or copayments, deductibles and costs above the annual maximum.


It's also important to note that at the end of the day, your employer chooses your insurance carrier and the dental insurance package they wish to offer their employees. As a dental provider, we are not the main customer of the insurance carrier -- rather, your employer is. Keeping this in mind, we can work together with the patient and insurance carrier to make sure you receive the most out of your dental insurance. However, sometimes it may be beneficial to involve your HR department for assistance as they are the primary customer of your insurance carrier.


Dental Insurance is Very Different From Medical Insurance

Both medical and dental insurance exist to help patients pay for healthcare expenses. Beyond this, the two insurances are actually quite different. Unlike medical insurance, most dental insurances do not have a high deductible or high or unlimited maximum. Dental insurance is also not designed to cover all the necessary treatment you may need. Instead, dental insurance is more similar to a coupon or discount program: coverage is meant to be helpful but not a catch-all, and generally dental insurance is designed to cover common, expected treatments like cleanings or fillings, but not necessarily large, unexpected treatments.


Regardless of your insurance plan, we will only recommend treatment that is necessary. Your treatment plan is guided by your dentist's commitment to give you a healthy and long-lasting smile, and not by your insurance benefits.


If we observe an oral health concern, we will use an intra-oral camera, a camera for your mouth, so you can see exactly what we see and together we can assess when and if treatment should be administered. Our digital full-mouth x-rays also provide a greater view of your oral health. By using the latest modern digital technology to document your dental care, you can be confident that you're being served with integrity and honesty. If any any point you have questions or concerns about the treatment we are recommending, we encourage you to ask us directly so we can explain and help you understand.


We’re on Your Side -- Not Dental Insurance Companies

After we design your treatment plan, we will also prepare a financial arrangement for you. We also contact your insurance company to get the details of your insurance coverage and estimate your out-pocket-costs. Although we do our best to get the most accurate information, we cannot guarantee the information your insurance company provides to us is up-to-date. What your insurance company ends up covering may also change and they may not approve your claim for various reasons.


We strive to properly document your condition along with intra-oral images and x-rays, to increase the chances your claim will be approved. We will do all we can to help you make the most of your insurance benefits and lower your out-of-pocket expenses. Rest assured that we’re on your side - not the dental insurance company - whenever it comes to your dental care.


The Confusing Explanation of Benefits

After your treatment, you may receive an Explanation of Benefits (EOB) from your insurance in the mail. The EOB is not a bill and may not reflect any payments that you made during your appointment. Many patients often find this confusing and we completely understand. Please review it carefully and if you think there's a mistake, contact us immediately and we’ll go over it with you and fix it if we need to. If you ever have any concerns or questions about a letter you receive from your insurance company, please do not hesitate to contact us.


Communication is Key

We know that when it comes to dental insurance things can get confusing and frustrating. You may even wonder whose side we’re on. We’ve built our practice on our patient’s confidence that we’re always on their side. Our goal is to make sure that your dental insurance works for you and that you get the most benefit from your coverage  We would never want miscommunication or finances to get between us, so if you ever have any concerns or questions about billing or insurance benefits please do not hesitate to contact us.


We want to help you achieve your best possible dental health, and utilizing your insurance benefits is just one way to do so. Let's work together to make this year your best yet.

If you're due for a visit or have any questions about your dental health, don't hesitate to contact our office to schedule an appointment.


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