Insurance Overview

Claims and Service Tips

There are many opportunities to get the most out of your dental plan. By taking advantage of them, you can lower your out-of-pocket expenses, save time, and achieve a higher level of satisfaction with your overall experience.

Choose a network dentist

It's generally in your best interest to pursue treatment from an in-network dentist. This will save you money and give you additional confidence in that dentist's credentials. Your in-network dentist may even be willing to reduce their fees for services not covered under your plan, such as cosmetic treatments.

If your dentist is not in your plan's network, you can encourage them to consider joining. To make this easier, many dental plan administrators provide a service that enables plan members to nominate their dentist to participate.

Get a pre-treatment estimate

When your dentist recommends expensive dental treatment, a pre-treatment estimate can help you evaluate your expected coverage and what you can expect to pay before you receive care. It may also help you identify less costly treatment alternatives. Dentists will typically submit a pre-treatment estimate on your behalf.

Use a health savings account (HSA) or flexible spending account (FSA)

HSAs and FSAs are savings accounts offered alongside qualified plans that provide tax advantages for healthcare costs. Money in these accounts can be used to pay for deductibles, co-payments, coinsurance, and other qualified healthcare expenses. Because of the tax advantages, these accounts can help you lower your out-of-pocket expense and save money when you use the funds to pay for eligible expenses.

You may need to select the amount you want to fund in these accounts during your HSA or FSA plan's open enrollment period. In addition, some of these accounts have a "use it or lose it" provision which states that any remaining account funds are forfeited at the end of the plan year. Because of this provision, it is essential to consider your healthcare needs carefully and assess the amount of money you will contribute to either type of these accounts to avoid over-funding the account and losing money.

There are important differences between HSA and FSA accounts. You should read and understand your plan documents before enrolling in either of these types of accounts. Some differences include the types of health plans you can use, annual contribution levels, rollover restrictions, and whether you can take unused money with you if you change jobs.

Filing claims

Most dentists will file dental claims on their patient's behalf. Some do not. Filing your own dental claim can be cumbersome. You will have to obtain the service information from your dentist to include with your claim. In addition to procedure codes and the dentist's charges, your plan administrator may also request that you include such things as X-ray images and treatment notes. If your dentist does not offer this service, you may wish to consider using an in-network dentist, as most participating network dentists submit claims on behalf of their patients.

In addition, a growing number of dental plan administrators process claims in real time. When this service is available, it enables you to immediately understand your out-of-pocket cost obligations and settle your bill before you leave the dental office.

Take advantage of technology

For a faster, more convenient experience, take advantage of the resources your plan administrator and dental practice provide. Many plan administrators and dentists offer services such as:

  • Online eligibility verification.
  • Digital insurance ID cards.
  • Online Explanation of Benefits (EOB) statements.
  • Text or email appointment reminders.
  • Text or email claim status updates.
  • Online treatment cost estimator tools.
  • Comprehensive digital oral health libraries that can help you understand your oral health risk and prepare you for upcoming treatment.
  • Author: Fluent staff
  • Last updated: 11/21/2022
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