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Dental Insurance for Implants
- Thread starter Rossat
- Start date
- Thread starter
- #13
I'm asking because I don't know. I don't know because I haven't learned it. I won't learn it if I don't ask.... Not every agent deals with stand-alone dental coverage, and because of the vast amounts of products, I'd be foolish not to take advice of more experience agents.
- 6,527
Caveat, not an agent.
I understand asking about Dental Insurance. I have had to try to learn some things about it myself in the last few months because of dental problems I am experiencing.
The thing that it appeared to me that you were asking is if one could purchase dental insurance and have it cover dental services provided prior to the effective date of the policy. I have seen that discussion in threads here over a variety of types of insurance. From reading those threads, I would expect any insurance agent to know the answer to that question regardless of the type of insurance for which the question is posed.
On the other hand, if you were asking if a dental patient had a crown placed when they were covered by a dental insurance policy, but the provider did not file a claim at that time, can a claim be submitted at a later date for that service, the answer to that question should be yes, IF the claim is submitted withing the carrier's time frame for submitting claims for a service.
A very specific example. I have an outstanding bill of over $1300 at a dental provider for a crown placed in May. I just this week checked with my dental insurance carrier to see if a claim has been filed. They told me no, but not to worry because the provider has 1 year and 90 days from the date of service to file the claim. So my account could show a balance for awhile.
What I have see is Defined Benefit Dental Plans generally place their services in 3 layers; Preventive, Basic and Major.
They will usually have deductibles ranging from $50-$100. Usually those are per person per year. Sometimes there will be no deductible, sometimes there will be a lifetime deductible, sometimes the deductible will not apply to preventive services.
There will most often be annual caps on the dollar amount of benefits paid for. Somewhere in a range of $1,000 to $3,000 is the most common I've seen. There are plans with caps above and below those amounts. Orthodontics will usually have lifetime caps of $1,000 to $2,000.
You can commonly find plans that have no waiting periods for preventive services. (DO NOT assume that the preventive services provided by all plans are the same. I have seen xrays that some plans treat as preventive placed in basic services in other plans. I have seen some plans that only cover 1 cleaning per year instead of 2, and so on.)
A few plans will also give you no waiting for Basic services, or sometimes a reduced waiting period of 4 or 6 months for the basic category (others will stick with a full 12 month waiting period for this category).
Major services usually have a waiting period of 12 months.
IF you have had other dental coverage including Major Services (say coming off an employer plan) and follow the carrier's documentation steps, some carriers will waive their waiting periods (for example I currently have 3 dental plans. I was able to have waiting periods waived for the secondary and tertiary plans because of the primary coverage I have.)
Plans that will cover implants and orthodontics will probably cost $70 +/- per month. It is quite likely that most of your prospects that want those services will NOT have or NOT have had recent coverage that will waive waiting periods so they will have to pay 12 months of premiums and then can get treatment just up to the annual cap of the plan. Crowns and root canals have a similar problem, but they cost less so if one has a plan with a $2,000 - $3,000 annual cap with a good provider network, getting a root canal and crown covered is possible.
You would have to ask your dentist, but I think it may be possible that the CROWN PORTION of a dental implant MIGHT be covered under a dental plan that includes coverage for crowns.
Some carriers are also going to have different plans and premium levels for under 65 and 65 and over.
If you are wanting to have dental insurance products to offer, my personal (non agent) suggestions would be to look at UHC, the Manhattan Plans @rousemark talks about and the afeusa Delta Dental plan that @Travis Price offers. (you would have to ask him, but that afeusa plan may also cover implants.)
Carrington provider 20% of contracted rate 1st yr. 50% thereafter
Non Carrington Provider: 20% of UCR 1st yr. 50% thereafter
$3,000 benefit , $0 Deductible ages 65 - 74 $53.76 - $100 Deductible $48.90.
Implants limited to $1500 lifetime benefit.
The buzzard that replied is not an agent, so . . .
- 6,527
@DS4 's post 34 and other comments in this thread:
https://insurance-forums.com/commun...s-you-may-not-need.104848/page-4#post-1383725
may also be of use to you. Using zip 17043, it looks like Delta Dental of CA and Delta Dental of PA may be closely enough related that that link will work for you also.
I do not know if any of those plans include coverage for implants.
- Thread starter
- #18
I really don't mean to be rude, but you have assumed a lot of things which just generally are not true.
You said : The thing that it appeared to me that you were asking is if one could purchase dental insurance and have it cover dental services provided prior to the effective date of the policy.
I wasn't. I was asking if there is dental insurance that covers implants. Not that it would cover before the effective date.
You said: On the other hand, if you were asking if a dental patient had a crown placed when they were covered by a dental insurance policy, but the provider did not file a claim at that time, can a claim be submitted at a later date for that service, the answer to that question should be yes,
Again, that's not what I was asking in any shape or form. I was asking if crowns for implants would be covered if implants were not
I understand you are really trying to be helpful to many, I get it. But I have seen a number of your posts even before being a member myself and it seems, to me, you speculate more than asking for information. Again, not trying to be mean, but perhaps you should learn when it's best to keep your opinion to yourself. After all, even what you explained is an opinion and does not apply to every coverage.
@rousemark Is this the provider list one should use for the Manhattan dental plan?
Find a provider near you | Careington
Looks like only 2 plans included in the search . . . DXDU and C500
Which of those plans identify the Manhattan plan?
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Those are Carrington's own direct plans and have nothing to do with Manhattan other than any Carrington dentist also qualifies for the discount under the Manhattan Plans. (Or at least that is the way I understand it}
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