Insurance & Billing FAQs
Do you have insurance and billing questions? We're here to help! Here is a list of the most commonly asked questions (along with answers).
First Choice Dental accepts most major insurers, including Delta Dental, Humana, Anthem, MetLife, and more. Check out the latest list of insurance plans we accept to see whether First Choice Dental is a preferred or in-network provider for you. If your dental insurance plan is not on this list, rest easy. You can still use our services, and we will be more than happy to care for your smile. Many dental plans will allow you to seek dental care outside of their network, and many do not reduce your benefit level for doing so. Our staff can advise you about your dental benefit plan and your ability to seek out-of-network dental care. Contact us for information specific to your plan, or contact your benefits specialist or plan administrator.
It is common for dental insurance plans to exclude or discourage even necessary dental treatment such as sealants, pre-existing conditions, adult orthodontics, specialist referrals, and other dental needs. Some plans exclude treatment that is covered under the insured individual's medical plan. Patients need to be aware of the exclusions and limitations in their dental plan, but should know that these exclusions and limitations will not impact the treatment that your doctor recommends.
This should be a prime consideration and a major motivation in choosing one plan over another. If your employer offers more than one plan, look at the exclusions and limitations of the coverage as well as the general categories of benefits. You should discuss your family's current and future dental needs with your family dentist before making a final decision on your dental plan.
You can always go to the dentist of your choice. The question is whether you will have benefit coverage for the treatment you receive if you see a dentist who is not on the plan's list. This depends on contractual agreements between the plan purchaser (often your employer), the dentist on the list, and the plan administrator. Under certain contracts, such as a PPO (Preferred Provider Organization) program, patients are given a financial incentive to go to certain dentists, but do not receive some level of dental benefit regardless of the treating dentist. Other plans, such as the capitation programs, do not provide any benefit coverage for treatment give by "non-participating" dentists.
Your program covers you. Your spouse's program covers him/her. You may have additional coverage from each other's programs if they cover spouses and dependents. In no case should the benefit be derived form the two coordinated programs exceed 100 percent of the dentist's charges for treatment.
The primary plan for covering your children depends on the terms of the specific plans. Most plans use the "birthday rule" (spouse with birthday occurring earlier in the calendar year is primary). Others consider the father's plan primary. The American Dental Association has recognized the "birthday rule" as the preferred method for coordinating benefits, but which rule applies to your family depends on the language in your dental plan documents. If you have two or more potential sources of coverage, check the coordination of benefits language for each plan to determine benefits available.
Typically, no. However some insurance companies request a "predetermination of benefits" on certain treatment plans. Usually this means a dental consultant will review your dentists treatment plan and will provide an estimate of what benefits your plan will provide.
There may be a provision in your plan that will deny your normal dental benefit plan or reduce the level of coverage if you do not submit the treatment plan prior to authorization. This is a contractual matter between the plan purchaser (often your employer) and the plan administrator, and is contrary to the policy of the American Dental Association. The American Dental Association is opposed to any dental clause that would deny or reduce the payment to the beneficiary to which he/she is normally entitled, solely on the basis or lack of preauthorization.
First Choice Dental is always happy to send a predetermination of benefits upon your request.