GEHA PPO Exclusions, Limitations, Frequencies and Missing Tooth Clause
Like all insurance plans, GEHA PPO Dental insurance plans help to defray the cost of dental care. GEHA PPO Dental insurance covers a portion of dental procedures. Some procedures recommended by Sunnyvale Dentist Dr. Antonious may be excluded by your GEHA PPO Dental insurance plan, not because they are unnecessary, but because businesses including insurance companies strive to reduce their cost by limiting the amount that they have to pay on claims. These exclusions vary depending on which plan you or your employer has chosen.
Dental insurance plans also have limitations/frequencies. These determine how many examinations and dental cleanings you may have each year, how often dentures may be replaced, and how often dental procedures such as crowns and fillings may be done on each tooth.
Limitations may also affect the type of dental materials covered by your GEHA PPO Dental insurance plan. For example on posterior or back teeth, some policies will pay more for amalgam silver fillings than they will pay for more attractive bonded tooth colored composite fillings. The patient then has to pay the difference in cost between the amalgam and composite fees.
When it comes to replacing missing teeth, some insurance plans will cover a removable partial denture instead of a more stable fixed bridge or dental implant. Because of these variables in coverage, some patients request a predetermination of benefits prior to beginning treatment.
Some dental insurance plans have a Missing Tooth Clause. If a tooth is lost before the insurance plan begins, the patient is responsible for 100% of the replacement cost. Procedures to replace missing teeth include bridges, dental implants and full or partial dentures.
Sunnyvale Dentist Dr. Antonious will help you maximize your plan benefits by presenting all possible treatment options. Insurance coverage is an important consideration, but should not be the only factor when determining treatment.
Explanations of individual plan exclusions, limitations, frequencies and missing tooth clause are contained in benefit booklets given to subscribers (person purchasing coverage) online or in print.
The Sunnyvale Dental Care insurance coordinator can also research this information for you. It is important to understand the details of your GEHA PPO Dental insurance plan. The team at Sunnyvale Dental Care understands these details well and will be happy to explain them to you.