Because our dentist practice is close to the Washington/Oregon border, it’s not uncommon for patients from Oregon to travel across the border to see us. Some new customers may be hesitant to go across state boundaries for a dental appointment because they are unsure how their dental insurance coverage will be affected. In this piece, we’ll address some typical worries regarding going to the dentist over state borders.
Dental care quality is determined by your dentist’s ability and experience. Dental care, on the other hand, is more or less the same from state to state. The only thing that makes things more complicated is how you pay for your dental care.
You don’t have to worry about receiving approval for any dentist in the country if you’re paying cash. You should be able to find a dentist in any place without difficulty, and you should not have to worry about insurance coverage. Things can get a little more complicated if you have dental insurance.
You will most likely be covered for out-of-state dental appointments if you have dental insurance via a major provider. Smaller providers may have fewer options for coverage and may only compensate in-state dentists.
In-network vs. out-of-network dentists is a crucial element in deciding the cost of out-of-state dental care. Insurance companies pay you differently depending on the sort of doctor you see. It doesn’t mean you can’t see a dentist who isn’t in your network; it just means your co-pay will be lower and your out-of-pocket payments will be greater.
Larger insurance providers may have a nationwide network of in-network doctors. Out-of-state options for in-network dentists may be more limited than those available in your home state, depending on your insurance company. Make sure to verify with your insurance carrier to see if the out-of-state dentist you’re considering seeing is in-network or not.
Make sure you check your insurance coverage before planning a trip to see an out-of-state dentist. This is necessary to guarantee that you are covered if you travel out of state for dental care, as well as to determine whether the dentist you intend to see is in-network or not. A brief search on the website of your insurance carrier can assist you in determining the appropriate cost expectations for your dental care.
On their websites, most insurance companies include a dentist search option. To access the information you need, go to your insurance company’s website, log in to your account, and do a provider search for dentists.
There are several compelling reasons to seek treatment from a dentist outside of your own state. The cost is first and foremost. The cost of living in some states or metro areas is higher, which includes dental care. Traveling across state boundaries may take you to a location with a cheaper cost of living and lower dental operation costs. In some places of the country (such as our hometown of Vancouver, Washington), you can go from a huge metro area (in our instance, Portland, Oregon), pass a state boundary, and arrive in a smaller city with lower rates. When you go to the dentist, a few more minutes in the car could save you a lot of money.
We invite our neighbors in Portland, Oregon, as well as our Vancouver friends, to pay us a visit. To make an appointment, call our office today!
Is dual dental coverage worth it?
You have dual dental coverage if you are covered by two distinct dental insurance plans. When you have two jobs that both provide dental benefits, or you are covered by your spouse’s dental plan in addition to your own, you have dual dental coverage.
Although having dual coverage does not increase your benefits, you may pay less for dental operations than if you only had one plan because treatment costs may be divided up to 100% between your two carriers.
1
Contractual language will be included in all dental plans to define how coordination of benefits (COB) will be handled between the two plans and how it may affect your out-of-pocket payments. Because state laws and regulations play a significant part in deciding how insurance benefit coordination works, there may be differences in how it works in your state, so check with your insurers to find out how COB works for you.
Some COB regulations place restrictions on what a plan can cover, while others entail a lengthy process.
COB provisions may also be influenced by state laws and regulations, as well as other factors that differ by state.
When COB is used, one dental plan becomes main, and the other becomes secondary. Most of the time, the secondary policy will not accept a claim until the primary policy has paid for services based on the enrollee’s available benefits. The secondary policy will next request from the primary insurer a copy of the payment information (also known as an explanation of benefits, or EOB).2
Your two carriers will make sure that the total amount paid by the two plans does not exceed the total amount the dentist has agreed to take from the primary carrier if you have dual coverage. The total allowable charge is what it’s called. In other words, the aggregate benefits from the two carriers do not exceed the total dentist charges, and there is no benefit duplication.
Dual coverage, as appealing as it may appear, does not imply that you will enjoy double the benefits. You may: I receive benefits up to the entire amount you paid for the treatment, (ii) pay a lower co-pay than if you just had one plan, or (iii) receive no additional benefit from your secondary plan, depending on your benefit plan and state restrictions. Your dental plan and the prices your group pays for your coverage include dual coverage limitations.
Let’s say you have dual coverage and each of your plans covers two cleanings each year at a rate of 75%. Due to the constraints of dual coverage, you can only claim two cleanings per year; however, your primary carrier will reimburse 75% of the cost of each cleaning (its maximum plan allowance). After obtaining the EOB from your primary carrier, your secondary carrier may cover up to the remaining 25% that you would have otherwise paid out of pocket, depending on the language in the secondary carrier’s contract and state rules (traditional COB language). It could also be a lower amount, resulting in a lower co-pay than if you only had one coverage (maintenance of benefits language). Alternatively, the secondary carrier may refuse to pay the remaining 25% because the primary carrier has already paid the other 75%. (non-duplication of benefits language). Examine your dental plan contract to see how it applies to you.
The major carrier is the one for which you are a member (e.g., your employer’s dental insurance rather than your spouse’s). If you work two jobs, your primary dental plan is the one that has given coverage for the longest time.
When does the secondary insurance kick in? The secondary carrier will usually not accept a claim until the original carrier has paid it. A copy of the original payment information, or EOB, is frequently required at this time by the secondary policy. In this circumstance, state laws and regulations frequently require COB.
COB restrictions will vary according on your dental plans, insurance companies, state legislation, and other considerations. If you have two dental insurance policies, make sure you speak with both of them to fully understand whether and how dual coverage could benefit you. Inquire about their COB provisions and the benefit level to which you are eligible. You could also seek advice from the human resources department of your employer. If you value the combined level of insurance, be sure you understand COB for your dental policies before committing to any major dental procedure.
Are you looking for individual dental insurance or further information? Brush up on the fundamentals of dental insurance:
Why dental insurance is separate?
Dr. Adam C. Powell, president of Payer+Provider Syndicate, a management advisory and operational consulting firm focused on the managed care and healthcare delivery industries, says, “The reason dental is separate from medical is because the nature of the risk is fundamentally different, as is the deferability of the care.” “You’ll go to the ER right away if you’re having a heart attack.” Dental issues may, and regrettably, frequently do, be postponed. It’s possible that the situation will worsen, but it’s not always life-threatening.”
Yes, dental issues can often be postponed. Mine is on hold till I am paid again (or three). However, the claim that dental problems are less serious than “medical” concerns does not hold water, especially when considering the amount of ER visits attributed to dentistry-related issues.
Is Delta Dental accepted in Massachusetts?
Delta Dental Individual and FamilyTM – Premier has the broadest coverage and the most dentists in its network. In Massachusetts, Delta Dental Individual and FamilyTM EPO provides inexpensive coverage with access to Delta Dental’s EPO network.
Is Delta Dental A good insurance?
Delta Dental coverage is often regarded as the top standard in dental insurance. Since 1954, the company has provided insurance and now offers both PPO and HMO plans. Delta Dental should be one among the first firms you examine for dental coverage, with consistently good financial stability ratings and more than 155,000 participating dentists around the country.
What is a missing tooth clause?
A “missing tooth provision” is included in the great majority of dental insurance plans. A missing tooth provision prevents the insurance company from covering the cost of replacing a tooth that was lost before the policy was issued. To put it another way, if you lost a tooth before getting dental insurance and then intended to replace it with a partial, bridge, or implant, your insurance company would not cover any of those services if your plan had a missing tooth provision. Your insurance company may also include a restriction indicating that they will not pay to replace a partial, bridge, or implant that you had placed prior to having that specific insurance coverage, or that they would not pay to replace it before a certain time limit has passed.
Can you be double insured?
Yes, you are allowed to have two health insurance policies. It is completely lawful to have two health insurance plans, and many people do so under specific situations.
What does no dual insurance mean?
When you have multiple dental insurance plans, some of them contain a non-duplication of benefits clause that applies. This means that if the main plan paid the same amount or more for the same service than the secondary plan permits, the secondary plan will not pay any benefits.
A maintenance of benefits clause is used in some dental insurance plans. This subtracts the amount the primary plan has already paid from covered expenditures before applying the plan deductible and co-insurance requirements.
A carve-out coordination strategy is used in other plans. This first calculates the amount that would have been paid in plan benefits, then subtracts the amount that has actually been paid by the primary plan.
Check the terms of your secondary policy to see if it has a carve-out, maintenance of benefits, or non-duplication of benefits clause.
Why is dental work so expensive even with insurance?
You’re not alone if you’ve ever struggled to pay for dental treatment. That’s because in 2010, 181 million Americans avoided going to the dentist.
While most Americans can afford simple dental procedures such as fillings and cleanings, the cost of care rises dramatically as procedures get more sophisticated. Root canals, bridges, and TMJ surgery can cost thousands of dollars, with insurance covering only a part of the costs.
This has sparked a debate about whether dental care is a luxury or a need. Is dental care absolutely necessary? Is it a luxury reserved for those who are fortunate enough to be able to afford it, or is it a luxury reserved for those who are fortunate enough to be able to afford it?