How dental plans work
Most dental plans are either the result of a contract between your employer and an insurance company or purchased privately for individual or family coverage. In the case of an employer plan, the amount your plan pays is agreed upon by your employer with the insurer. For individual or family plans, the coverage would depend on the plans and options of the selected insurance company. Your insurance coverage is not based on what you need or what your endodontist recommends. It is based on the plan options selected by your employer (or the level of individual or family coverage you have purchased). Many dental plans cover some, but not all, dental costs.
Root canal treatment may be covered by dental insurance depending on your coverage. If there is a copay, coinsurance, or other balance due, it will be disclosed before treatment begins. Any dental services performed without prior financial arrangements must be paid in full at the time of treatment. For your convenience, we accept the following methods of payment: Cash, Credit Cards (Visa, MasterCard, Debit and American Express), and Care Credit (pending approval).
As a courtesy, we submit your insurance claim for you. We try our best to determine your insurance coverage and benefits so that we may give you an accurate estimate of your coverage. However, this estimate is not a guarantee of coverage by your insurance plan and you will be solely responsible for the total amount should your insurance not pay the expected portion.
This is the largest dollar amount your dental plan will pay during the year. Annual maximums can vary and depend on the contract with the insurance company. You are expected to pay any applicable copayments, coinsurance, or deductibles, as well as any costs above the annual maximum.
Your dental plan might want you to choose dental care from a list of its preferred providers (or in-network providers), endodontists who have a contract with the dental benefits plan. If you choose to receive dental care from outside the preferred provider group (out-of-network), you may have higher out of pocket costs.
Coordination of Benefits (COB) or Nonduplication of Benefits
These terms apply to patients covered by more than one dental plan; perhaps you are insured by your employer and are also on your spouse’s plan. Insurance companies usually want to know if you have coverage from other companies as well so they can coordinate your benefits. For example, if your primary insurance will cover half the bill, your secondary insurance will not cover that same portion of the bill.
Benefits from all companies should not add up to more than the total charges. Even though you may have two or more dental benefit plans, there is no guarantee that all of your plans will pay for your services. Sometimes, none of the plans will pay for the services you need. Each insurance company handles COB in its own way. Check your plan for details.
Root canal or endodontic treatment is necessary when the inside, or pulp of a tooth becomes inflamed or infected. The pulp contains the nerves and blood vessels which keep the tooth alive. It is through the pulp that temperature and pain are perceived. The inflammation or infection can have many causes but usually are the result of deep decay or trauma.
Explanation of Benefits (EOB)
An EOB is a written statement from the insurance company telling you what they cover and what you must pay yourself. You are responsible for any portion of the bill that is not covered and is payable to the dental office.
Which insurance plan do you accept?
We are in-network providers for most major insurance PPO and some HMO plans. Please contact our office for full list of insurance companies we participate with.