Question 1

How can I check what my out-of-network benefits are?

Accepted Answer

You can always check with your insurance company to find out what they are and how much they cover. However, the Iconic Dental team can check for you and give you an exact break down. All we need is your Carrier name and subscriber ID.

Question 2

How can my exam be $0 if I am out-of-network?

Accepted Answer

In many instances, out of network benefits cover preventative services at 100%. Your exams and cleanings are considered preventive by Iconic Dental and your insurance! Give your info and we’ll tell you exactly what is covered and how much you’ll owe.

Question 3

What is the difference between being in-network vs. out-of-network?

Accepted Answer

Being out of network simply means Iconic Dental does not have a direct contract with your insurance provider. It does not mean we don’t take your insurance. We take all insurances except a selected few. For those carriers that we do have a direct contract with, they have negotiated prices. When out of network, we use the base price for the service and apply the coverage percentages corresponding to your out-of-network benefits to calculate what you’ll owe.

Question 4

Is dental insurance different from medical insurance?

Accepted Answer

The basic premise of dental insurance is the same as other types of employer-provided insurances such as Medical and Vision. Most dental insurance is provided by your employer, has monthly premiums associated with that coverage, has guidelines on who you can see, and differences in benefits provided. The major difference with dental insurance is that the insurance provider has a yearly maximum they will reimburse, whereas a medical insurance provider covers reimbursement after the individual reaches their own out of pocket maximum.

Question 5

How does dental insurance work?

Accepted Answer

Dental insurance works similarly to your medical insurance, with the main difference that the Insurance provider is responsible for “First Money Out”, meaning they cover up to a “Maximum Allowable” amount in a given benefit period (usually a year) and the patient is responsible for any amount over that limit. The Maximum Allowable amount is unique to your insurance plan and is important to know what it is when seeking more expensive care. Further, as with Medical Co-Insurance, Dental PPO plans typically cover services based on ranges or categories: Preventive, Basic, and Major. As an example, most PPO coverages provide 100% coverage for Preventive services, 80% coverage on Basic, and 50% for Major. This breakout is plan-specific and you will need to consult your personal benefits to understand your coverage. What is not covered by your insurance is the patient’s responsibility.

Question 6

What does my dental insurance cover?

Accepted Answer

Typically, dental insurance covers all types of dental care ranging from exams and cleanings (typically 2x / year), basic dental care (fillings, crowns, etc.) to oral surgeery and orthodontics. Insurances categorize each type of care into Preventive, Basic, and Major services and each is covered at a determined percentage, leaving the remainng balance to the patient (typical breakouts are 100% / 80% / 50% for the coverage percents). Orthodontics are unique and typically have rules around age, who on your plan is allowed to use, and how much is offered (i.e. there is a lifetime max versus and annual amount).

Question 7

What is PPO dental insurance?

Accepted Answer

A PPO is a “Preferred Provider Organization”. PPOs do not require you to choose a primary dentist, although one is recommended. You don’t need referrals to see specialist, either, but you will save money if you see on in your plan’s network. These differ from DHMO insurance plans that typically cover dental services at a low cost and minimal or no copayments with a pre-selected primary care dentist or a dentist facility with multiple dentists. You are required to select a Primary Dentist and are restricted to that Dentist unless otherwise referred to a specialist

Question 8

How many cleanings and exams does dental insurance cover per year?

Accepted Answer

In most cases, two exams and cleanings in a calendar year.

Question 9

How much is a dental cleaning and exam without insurance?

Accepted Answer

$179

Question 10

Are dental implants covered by insurance?

Accepted Answer

In most cases, yes. However, there are exceptions and rules that are important to know prior to your visit. For instance, an implant would not be covered if you were previously missing your tooth and your coverage includes a “Missing Tooth Clause”. At Iconic Dental, we can help you determine which rules are in place for your specific coverage.

Question 11

Does dental insurance cover braces?

Accepted Answer

In most cases, yes. Orthodontics are unique and typically have rules around age, who on your plan is allowed to use, and how much is offered (i.e. there is a lifetime max versus and annual amount). At Iconic Dental, we can tell you what rules are in place for you specific coverage.

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