Dentist in Middleburg
Frequently Asked Questions
Asbury Family Dentistry, a Dentist in Middleburg, receives many different questions on a regular basis about insurance. For your convenience, below you will find some of the most frequently asked questions we receive. If you the below FAQ’s do not answer your question or if you still need further clarification please do not hesitate to contact us.
1. Why can you only estimate my coverage?
Dentists in Middleburg and Green Cove Springs FL deal with thousands of plans and hundreds of types of dental treatments each year. Most carriers refuse to release the details of their plans. They change policies and reimbursements constantly and without notice. In addition, there are downgrades for various items which leave the patient responsible for the difference. For example, most insurance companies will still only pay for metal fillings and metal crowns, despite evidence showing that the metal material ‘leaks’ over time and causes exposure to the repaired tooth.
2. Why is there an annual maximum on my benefits?
Maximums limit what a carrier has to cover each year. Amazingly, despite the fact that costs have steadily increased, annual maximum levels for dental care have not changed since the 1960’s.
3. Why does my dental plan only pay toward the least expensive alternative treatment?
To save money. Your dentist may recommend a crown, with your insurance only offering a benefit toward a dental filling. This does not mean you have to accept the filling. The good news is that some benefit will be paid: the bad news is that more of the fee will be your responsibility. Remember that your dentist’s responsibility is to prescribe what is best for you. The insurance carrier’s responsibility is to control payments.
4. Why won’t my insurance pay anything toward some procedures, such as x‐rays, cleanings and gum treatments?
Your plan contract specifies how many of certain types of procedures it will consider annually. It limits the number of x‐rays, cleanings, etc. covered because these are the types of treatments that many people have frequently.
5. What should I do if my insurance does not pay for treatment I think should be covered?
Because your insurance coverage is between you, your employer and the insurance carrier, your dentist does not have the power to make your plan pay. If your insurance does not pay, you are responsible for the total cost of dental treatment. Sometimes a plan may pay if patients send in a claim for themselves. The Employee benefits Coordinator at your place of employment may be able to help. Patients may also lodge complaints with the state Insurance Commission.
6. What if my spouse has insurance?
Dental plans used to work together. However, may times you will get little or no coverage from a second plan. Consider any extra benefit an unexpected gift.