Insurance FAQ’s 

Dentistry at Daniel Markham Dental is easy, streamlined and simple because we’re experts at filing insurance claims and navigating varying coverage for a variety of plans. If you’re unsure of what services are covered under your plans or have questions about how your insurance works, we’d be more than happy to help answer them.
Below, we’ve outlined some general information to help you get a better grasp on how your dental insurance works.

Understanding How Dental Insurance Works

There are a few main terms that you should know to better understand your dental insurance and how your coverage works:

  • Maximum: Your maximum is a capped-off amount of money that your insurance will pay for dental treatments over the course of a calendar year.
  • Deductible: The deductible is a set amount of money that your insurance requires you to pay out-of-pocket before your benefits will kick-in.
  • Premium: The premium is the monthly or annual amount you pay for your benefits.
  • Coinsurance: The percentage of costs you pay after meeting your deductible, while the insurance covers the rest.

What Does My Dental Insurance Cover?

It’s important to keep in mind that every dental insurance plan varies, and to make sure that yours covers the treatment you need it to, you’ll need to call your insurance company directly. However, most plans determine coverage based on a 100-80-50 structure. This means that they cover 100 percent of the cost preventive care, like checkups and cleanings, 80 percent of basic treatments, like cavity fillings, and 50 percent of more serious procedures, like tooth extractions.

What If My Insurance Plan Is Out of Network?

We want to shed light on a common misconception that being out of network is a disadvantage. In reality choosing an out of network provider doesn’t always mean your insurance isn’t accepted and doesn’t always mean you pay more. While insurance companies may promote in network options, going out of network can allow you to select a dentist who truly prioritizes your health and wellbeing rather than adhering to restrictive insurance guidelines. Our team is dedicated to helping you maximize your dental benefits you. If you fall under an Out of Network plan, please come to us with any questions you may have regarding your coverage. 

Please call for more information about financing your dental needs in our office!