Cigna PPO Exclusions, Limitations, Frequencies and Missing Tooth Clause
Like all insurance plans, Cigna PPO dental plans help to defray the cost of dental care. Cigna PPO plans cover not all, but a portion of dental procedures. Some procedures recommended by Sunnyvale Dentist Dr. Antonious may be excluded by your Cigna PPO plan, not because they are unnecessary, but because insurance companies, like all businesses strive to reduce their cost by limiting the amount that they have to pay on claims. These exclusions vary depending on which plan you have chosen or that has been provided by your employer.
Dental Insurance plans also have limitations/frequencies. These determine how many dental cleanings and exams you may have each year, how often dentures may be replaced, and how often dental procedures such as fillings and crowns may be done on the same tooth. Limitations may also affect the type of dental materials covered by your Cigna PPO 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 fillings. The patient then has to pay the difference in cost between the two materials. When it comes to replacing missing teeth, some plans will cover a removable partial denture instead of a more stable fixed bridge or dental implant. Because of these variables, some patients request a predetermination of benefits prior to beginning treatment.
Some Cigna PPO plans have a Missing Tooth Clause. If a tooth is lost before the Cigna PPO plan coverage begins, the patient is responsible for 100% of the replacement cost. Procedures to replace missing teeth include dental implants, bridges, and full or partial dentures.
Sunnyvale Dentist Dr. Antonious will help you maximize your plan benefits by presenting all possible treatment options. Insurance coverage should be “A” factor, but not 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) in print or online. The Sunnyvale Dental Care insurance coordinator can also access this information for you.
It is important to understand the details of your Cigna PPO dental plan. The team at Sunnyvale Dental Care understands these details well and will be happy to explain them to you.