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Dental Definition – Covered Services

    Definition: Covered services are medical procedures or services which have been approved for payment by an insurance company. Insurance providers may have different terms or guidelines for covering certain services. Typically covered services must be deemed medically necessary.

    Most people know they need to visit the dentist regularly for dental care, but many don’t know that there are a variety of services a dentist can offer that isn’t covered by insurance. This blog post will discuss the concept of covered services and what they include. We’ll also describe the different types of covered services and what services aren’t covered. By the end of this post, you should have a better understanding of what services are available to you and what services aren’t. With this information, you can make an informed decision when it comes to your dental care.

    What Is A Covered Service?

    Do you want to know what dental coverage is standard on most dental insurance plans? Most plans include at least some basic covered services, such as oral exams, X-rays, and cleanings. Keep in mind that this coverage is usually less comprehensive than the full range of services that may be offered by a dentist at a private practice. In addition, some plans may cover only specific types of services such as fillings or crowns. Always check with your dental insurance plan to find out what services are included and what co-pays may be required. Now that you know what’s covered, it’s time to learn how to get the most out of your visit to the dentist!

    Types Of Covered Services

    Are you looking for dental coverage? Whether you’re a new patient or have been with your dentist for years, dental insurance can help to cover some of your expenses. There are a variety of dental insurance plans available, each with different coverage levels and limits on out-of-network services. Below, we’ll outline the different types of coverage that are available and the restrictions that apply.

    100% Coverage: This is the most comprehensive type of coverage and it includes in-network preventive and diagnostic services as well as basic services such as cleanings, fillings, and extractions. Out-of-network services are not covered, but in-network services may be provided by a licensed dentist outside of your network.

    80% Coverage: This level of coverage includes most of the same benefits as 100% coverage but excludes major procedures such as crowns and bridges. Basic out-of-network services may still be provided by a licensed dentist, but major procedures will not be covered.

    50% Coverage: This level of coverage provides 50% reimbursement for in-network preventive and diagnostic services plus 50% reimbursement for basic in-network services. Out-of-network services are not covered, but in­ network services may be provided by a licensed dentist outside your network. Major procedures (crowns/bridges) are not covered at this level.

    30% Coverage: This is the lowest level of dental insurance coverage and only covers 30% reimbursement for in­ network preventive and diagnostic care plus 30 % reimbursement for basic in­ network care. Out­of­ network services are not covered, but in­ network service may be provided by a licensed dentist outside your network if received within 60 days from the appointment date or within 60 days from the last visit if no appointment was made within 60 days prior to the visit date.

    What Services Are Not Covered?

    Dental care is vitally important, and it’s important to know what services are not covered by your insurance. Many people think that dental care is included in their insurance policy, but this is not always the case. Below, we will outline the various services that are not typically covered by dental insurance.

    Biopsies are not typically covered by dental insurance because they are considered medical procedures.

    X-rays are also not typically covered by dental insurance because they are considered imaging procedures.

    Cleaning and maintenance work done on teeth (such as scaling and polishing) is generally not covered either. This is because these tasks are considered routine maintenance rather than medical procedure.

    Some dentists may offer limited coverage for certain types of cleaning or repairs, such as fillings or extractions, but this varies from dentist to dentist and is usually subject to a doctor’s discretion.

    In most cases, dental implants and crowns are not typically covered by dental insurance either. This is due to the high cost of these procedures relative to other types of dentistry.

    Finally, root canals and dentures (both partial and full) are usually not covered by dental insurance either due to their high cost relative to other forms of oral care.

    Bottom Line

    A covered service is a type of insurance service that is provided by a health care provider. There are three types of covered services: inpatient care, outpatient care, and preventive care. Services that are not covered by insurance include, but are not limited to, cosmetic surgery, experimental procedures, and elective procedures.