Drs. Jong and Mischenko are participating providers with Cigna Radius PPO.
Don’t see your insurance listed here? Contact us to discuss your specific insurance.
Many of our root canal patients have questions regarding dental insurance and endodontic care. To help answer these common questions, we have prepared and compiled the following dental insurance FAQ.
Dental Insurance FAQs:
How much does a root canal cost? Each endodontic case is different and fees vary accordingly. Once an examination and consultation is completed, we will be able to tell you the fee and an estimate of how much your dental insurance will cover. Because dental insurance covers only part of the root canal fee, you are responsible for paying the remaining balance.
Why was my benefit different than what I expected? Many plans tell their participants that they will be covered “up to 80 percent or up to 100 percent,” but do not clearly specify plan fee schedule allowances, annual maximums or limitations (such as only 2 exams per year allowed, or 1 panoramic X-ray in 5 years). It is more realistic to expect dental insurance to cover 35% to 65% of our services. Nothing is ever covered at 100%. The amount a plan pays is determined by how much the employer has paid for the plan.
In addition, your dental benefit may vary for a number of reasons, such as:
You have already used some or all of the benefits available from your dental insurance.
Your insurance plan will pay only a percentage of the fee charged by your endodontist.
The treatment you needed was not a covered benefit.
You have not yet met your deductible.
You have not reached the end of your plan’s waiting period and are currently ineligible for coverage.
Why can’t you tell me exactly how much I will owe you for the treatment? At the time of service, your portion of the payment responsibility is only an estimate. Our office will perform a benefit check to assess your benefits under your plan as well as complete the dental portion of your claim form and submit it on your behalf. The amount of the precise financial responsibility is determined by your dental insurance company after the claim has been filed. A final statement is then issued to you. We recommend directing questions about your claim to your insurance company.
Why isn’t the recommended treatment a covered benefit? Your treatment plan is individually tailored, and is not based on your dental insurance benefits or lack of benefits. Some employers or insurance plans exclude coverage for necessary treatment as a way to reduce their costs. Therefore, not all endodontic treatment will be covered through your insurance plan. Some endodontic services (such as CBCT imaging for most dental plans) may be excluded. While we want to provide you with the highest possible quality of care, your dental insurance may cover only very basic services. The type of care you receive from our office is based upon our professional judgment and years of experience and not the coverage you receive from a dental benefit plan. We do not believe it is in your best interest to compromise any recommended care in order to accommodate your insurance program.
What is a dual coverage? This means that you have coverage from more than one dental plan. We only participate with primary plans. It is your responsibility to inform us which plan is your primary and to check whether we are in-network with that plan. If you fail to do so and your insurance company revokes the benefits paid on you behalf, you will assume the full responsibility for the fee.
“In-Network” vs. “Out-of-Network:” If we are “in network” with your insurance company, this simply means we have a contractual agreement with that insurance to only charge an agreed fee for the procedures that they cover. The insurance company will then pay the appropriate percentage of that fee. If we are “out of network” with your insurance company, we do not have a contract with that insurance and you are fully responsible for what our office charges.
How do I understand my Explanation of Benefits (EOB)? Your Explanation of Benefits (EOB) contains a wealth of information. The EOB identifies the benefits, the amount your insurance carrier is willing to pay and charges that are and are not covered by your plan. The statement includes the following information: UCR, co-payment amount/patient portion, remaining benefits, deductible and benefit paid.
How long does it take for a claim to be paid? The time for a dental insurance carrier to process an insurance claim varies. Maryland requires that dental insurance carriers pay claims within thirty days. If you want to file a complaint about a delayed payment, contact the Maryland Insurance Administration. They want to know if your insurance company does not pay within the required thirty days allowed by Maryland state law.
What if I still have questions? Many questions that you have may be best answered by calling your insurance company directly. While we will do our best to answer all your insurance question, please keep in mind that there are many insurance plans available and that your employer chooses your plan and your benefits. If you believe your benefits are inadequate, you may want to discuss the matter with your plan administrator and explore appropriate alternatives.