No one wants to hear that they need one or more dental procedures, but if the day comes when you find yourself staring at a dental treatment estimate, it can feel overwhelming. You may not understand all the information at first glance, but if you look at the estimate as a roadmap and break it down into sections, it’s a good way to help you make an informed decision about your oral health.
Decoding the Line Items
Many dental estimates are laid out in columns, so it’s best to read from left to right:
- Tooth — Each tooth has a number from one to 32. This column refers to which tooth needs treatment.
- Numeric code — This code is used by the insurance company and must match the treatment description.
- Provider fee — This is the cash price for the treatment before insurance is applied.
- Allowed amount — This is the amount that your insurance company allows the dentist to charge for the treatment. It only applies if your dentist is in-network.
- Insurance pays — This is the amount your insurance will pay.
- Patient co-pay — This is your out-of-pocket cost for the treatment.
Navigating Phased Treatment
You may want to consider completing your treatment in phases, especially if you need extensive dental work. Your dentist prioritizes your needs based on several factors:
- Phase 1 — The goal here is to provide urgent care and eliminate dental pain and infection. Treatments may include root canal therapy or extractions.
- Phase 2 — This phase focuses on controlling disease and stabilizing your oral health. Think periodontal treatment or dental fillings.
- Phase 3 — Rebuilding your smile with dental restorations is this phase’s objective. Crowns, bridges, and implants may be treatment options.
- Phase 4 — These are the least necessary, elective treatments, such as cosmetic dentistry.
What an Insurance Estimate Does (and Does NOT) Promise
A dental estimate will tell you that it is, in fact, only an estimate, not a guarantee your insurance will pay.
Here’s where it’s crucial to understand your insurance coverage; you’ll need to make sure you haven’t met your policy’s annual maximum or that you’re in a waiting period for coverage. There also may be limits to how often your insurance will cover a certain CDT code.
Looking for A Dentist in Newmarket, ON?
If you live in Newmarket or the surrounding area, we hope you’ll consider us for your family’s dental care! At Smilehaus Newmarket, we strive to help every patient achieve a healthy smile.
Feel free to reach out to us for all your oral health needs.