For anyone who has experienced the pain of an impacted tooth or suffered through the dental discomfort of a toothache, getting these issues resolved can make you feel like a million bucks. However, the real price tag when trying to understand the insurance cost and the dental cost terms can be challenging.
Thankfully, there are a few keywords to keep an eye out for when going over your dental bill. With these dental cost terms in mind, understanding billing will be as easy as brushing your teeth!
Who You See vs. How They’re Seen
When it comes to any healthcare procedure, you want to be sure that you are being taken care of properly. That not only means experience, but the right kind of experience. While many might use “dentist” or “doctor” as a catch-all term in the dentistry profession, the breakdowns of dental qualifications can be broad.
Most insurance companies want to keep track of which kind of dental health practitioner you’ve visited and when. So while you might see your dentist as simply “Dr. Hill” or Dr. S,” your insurance provider might categorize them as one of the following:
Dental Specialist: A dentist with postgraduate training in endodontics, orthodontics, oral surgery, pediatric dentistry, periodontics, or prosthodontics.
DDS: Doctor of Dental Surgery (The certification both Drs. Hill and Schneidmiller have.)
DMD: Doctor of Dental Medicine.
Endodontist: A dentist who treats diseases of the pulp and nerve—the inner fillings—of the tooth.
General Dentist: A primary dental care provider who provides preventive care and restorative procedures such as fillings, crowns, implants, etc. This describes Drs. Hill and Schneidmiller; however, they also perform many additional procedures than those listed above.
Oral and Maxillofacial Surgeon: A dental specialist that removes teeth but also treats diseases, injuries, defects, and deformities of the oral and maxillofacial regions.
Orthodontist: A dental health professional who straightens or moves misaligned teeth and/or jaw.
Pediatric Dentist: A dentist dedicated to the diagnosis, treatment, and management of the oral health needs of children.
Periodontist: A dentist who specializes in diagnosing, managing, and treating the tissue, gums, and bone that support the teeth.
The Legal Lingo
While identifying the particular dental professionals and their insurance cost is important, knowing the legal lingo that can be found in print is just as important. After all, dental cost terms are often designed for insurance agencies and dental office communication, not the patient.
When reviewing your next dental bill, keep an eye out for these important terms.
The Biggest A, B, and C
Allowable Charge: Arguably the most important dental cost term for a patient to recognize. This is the maximum dollar amount on which each benefit payment is based for every dental procedure, calculated by your insurance. In short, this determines/shows what your insurance will pay toward your balance.
Basic Services: Depending on your benefit provider, this term can be billed as Class II, Group II, or Type B services. Statistically speaking, these are the most common procedures a patient might undergo while visiting a dentist such as fillings, extractions, root canals, and root planing. Discovering billing discrepancies are made simpler when the majority of dental visits fall under this category.
Cost Sharing: When the treatment cost is shared by the insurer and the patient, the balance may include deductibles, co-payments, frequency limitations, and annual maximums which will all go into an insurer’s calculations before a finalized bill is sent.
How Knowing Your Benefits, Benefits You
It is important to remember that when it comes to dental costs, there are three main parties involved: the dental practice, the insurance company, and the patient—you. Two of the parties (your dentist and your insurer) will anticipate, calculate, and finalize your benefits as part of their day to day.
Drs. Hill and Schneidmiller and their team are dedicated to providing you with the best care with the best information regarding what to expect from your insurance company.
The more familiar you become with the insurance cost and dental cost terms, the more you can join in and contribute to the conversation.
Whether it is knowing which dental professional we might see (and how they appear on our bill) or understanding the lingo used by an insurance provider, you secure a better grip of the bottom line when you understand these terms. Thanks to this information, we can search for redundancies, billing discrepancies, and cross-reference terms for any out of pocket costs.
In short, knowing about your benefits can be one of your best benefits!