The following is a brief description of how your insurance plan works and some exclusions and limitations which it may have.

Most dental insurance companies break down their benefit levels into three categories; Preventative, Basic and Major.

• Preventative services consist of prophylaxis (cleaning), dental evaluations (check ups) and x rays. The majority of insurance plans cover these services at 100%.
• Basic services include fillings, root canals, periodontal procedures as well as oral surgery and are mostly covered at 80%-90%. While fillings are always considered a basic service, root canals, periodontal work and oral surgery could sometimes be considered a Major Service under certain dental insurance plans.
• Major services are crowns, bridges, dentures and implants all of which require more time for restoration or adjustment. These services are covered at 50%-60% by most major insurance companies.

It is important to understand that all insurance companies are different; therefore they all have their exclusions and limitations. Our staff does their best to verify all of your insurance benefits to provide you with the most accurate and up to date information. Although we maintain computerized histories of payment by a given company, they do change; therefore it is impossible to give you a guaranteed quote at the time of service. We estimate your portion based on the most up-to-date information we have, but it is ONLY AN ESTIMATE. If you would like to know your exact insurance benefit, we will be happy to file a “pre-treatment authorization” with your insurance company prior to treatment. This does delay treatment but will give you the exact out of pocket figures you may require.

Some dental insurance plans have the following plan exclusions:

Missing tooth clause – If a patient lost the tooth prior to getting coverage by their current insurance carrier, an implant, crown or bridge in that area will not be covered by the plan.

Downgrading - Most insurances downgrade composite (tooth colored) fillings for amalgam (metal) fillings on molar (back) teeth. They consider composite fillings on molars to be cosmetic and therefore pay only for the metal fillings which are a lesser fee. This makes the patient responsible for a greater co-payment amount.

If you would like to learn more about dental insurance or if you are not sure what benefits your dental insurance provides please call River Road Dental at (201) 840-0045 and we would love to verify your current benefits and explain them to you at your first appointment.