Understanding Dental Insurance

Having dental insurance can make obtaining quality dental care more affordable. 

At Nexus Dental, we recommend treatment based on the options for your specific condition. We will submit claims to your insurance company and advocate on your behalf, but ultimately expenses that your insurance company does not cover will be your responsibility.

Facts About Dental Insurance You Should Know

  • Many dental plans are based on a contract between an employer and the insurance company. They agree on the amount that the plan pays and what procedures are covered. If you have a dental care need that is not covered by your plan, you are responsible for that cost.  Because your dental office is not part of that contract with the insurance company, any information we have about a dental plan’s benefits comes from the general information the insurance company has provided about that plan (through a web portal, speaking to an insurance representative, or by way of a limited, faxed benefit summary).
  • A dental plan may not cover treatment for conditions that existed before you enrolled in that specific plan (such as treatment in progress). Even if your plan does not pay for certain procedures, you may still need that treatment to keep your mouth healthy. Your dentist will base your treatment plan on what you need, which won’t always align to what your insurance will pay for.  
  • Dental insurance rarely covers 100% of the services provided. Check your plan(s) for details regarding your dental benefit.
  • When we recommend a treatment plan, our team will be happy to provide you with an estimate of what your insurance will likely pay for the procedures. Although we cannot guarantee the amount of insurance payment, we will always submit claims to your insurance company. We will estimate your portion based on the general information that your insurance company provides for that plan. Just like with your medical coverage, you are ultimately responsible for any uncovered portion of the fee for treatment.

At Nexus Dental PC, our main goal is to partner with you to achieve a higher standard of oral health. We certainly understand that the insurance business is very complex and this complexity can lead to frustration. Our team wants to help you receive the maximum benefit that you are entitled to under your insurance plan by filing claims as a service to you. We would be happy to submit a pre-treatment estimate to your dental insurance provider.