There might be a waiting period for bigger procedures, it's the insurance companies way of making sure you don't buy a plan for 2 months and get all your major work done quick i guess!
There are also deductibles, usually some $50 per subscriber and $150 per family, so you might still have to pay something for your "free" benefits.
Procedures are typically grouped into 3 categories when it comes to coverage - preventive, which are usually covered 100%, like cleanings, x-rays or sealants, basic and major.
Basic procedures include gum disease treatments, extractions, fillings or root canals. Most plans cover 70% - 80% and Patients are responsible for the rest.
Most plans though don't cover cosmetic dentistry procedures, or the ones that are not considered "necessary", like laser or extra forms of anesthesia, including sedation. Patients chose to have those for a better standard of care or comfort, or to have a beautiful smile instead of just functional teeth.
Usually the dentist will submit the claims for you and receive the insurance portion of the payment. Sometimes the insurance pays way later or not enough for different reasons, and that usually becomes Patient's responsibility.
You should work with an "in-network" dentist, but most are, so it's usually easier to find your dentist searching online, on reviews apps like Yelp or Google Maps and Nextdoor or ask friends, than on your insurance's website. We find those to be wildly outdated, and include dentists who moved from the area years ago.
HMO plans work differently, there are no claims or co payments, there is only a discounted fee schedule, and a minimal visit fee. Usually, diagnostic and preventive services have no co-payment, so the Patient pays nothing for these. And major treatments have a lower fee, while there are no maximums or deductibles.
In a nutshell this should answer most questions, but if you need more info please call or text us at 949-425-1447, or visit https://www.AlisoViejoDental.com/
