FAQ

Dental insurance verification FAQs

Find answers to frequently asked questions about our dental insurance verification services. Click on any question to learn more.

FAQ

Frequently asked questions

Click on any question to learn more details.

Dental insurance verification is the process of confirming a patient's coverage, benefits, deductibles, and policy limits with their carrier before treatment so there are no billing surprises.

Most denials trace back to eligibility issues, missing pre-authorizations, coding errors, frequency limits, and missing tooth clauses — roughly 80% are preventable at verification.

In-network dentists have contracted rates with the carrier that lower patient out-of-pocket costs. Out-of-network dentists charge their usual fees and patients pay the difference.

Most plans follow a 100/80/50 structure — 100% of preventive care, 80% of basic procedures like fillings, and 50% of major work like crowns — up to the annual maximum.

The annual maximum is the most the dental plan will pay during a benefit year — typically $1,000 to $2,000. Once reached, the patient pays for any additional dental work that year.

Waiting periods are the months you must wait after enrolling before certain procedures are covered. Basic care often has 3-6 month waits; major work can require 6-12 months.

When a patient has two dental plans, coordination of benefits decides which pays first. The primary plan pays its share; the secondary covers eligible remaining costs.

A missing tooth clause excludes coverage for replacing teeth that were already missing before the policy started. It's a common reason implant and bridge claims get denied.

PPO plans let patients see any dentist with bigger savings in-network. DHMO plans require a contracted dentist but usually have no deductibles or annual maximums.

An EOB is the document a carrier sends after processing a claim — it shows what was billed, what the plan paid, and the patient's remaining responsibility. It's not a bill.

Most dental plans reset on January 1 — restoring the annual maximum and deductible. Some employer plans reset on the policy anniversary or fiscal-year start instead.

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