Dental insurance can be useful to receive dental work in America simply because dental work is too expensive to be paid out of pocket. Nonetheless, it is not news that dental insurance isn´t great either and many people do completely without it. In many cases even with an insurance copay, getting the dental work you need is not feasible. This is due to several reasons.
- Dental insurances have a yearly maximum, which means they will only pay out up to a certain limit. This limit will be higher or lower depending on your plan. Oftentimes, when there is an expensive procedure to be had, it will take up a lot of this maximum and will limit the ability to have additional work done. Oftentimes patients will have to wait an entire year until their maximums are restored in order to address another important dental procedure.
- Dental insurances have copay percentages. This means the insurance company will not pay 100% of the dental procedure. Generally, preventative procedures like cleanings and x-rays will have the highest percentage of copay. Then, basic procedures like fillings have a lower copay and major procedures like extractions, root canals and crowns are covered at an even lower percentage. Some dental plans do not even cover dental implants. This means that the more work you need, the more percentage you will need to pay out of pocket.
- Many procedures are covered conditionally. Insurance companies will be willing to pay if and only if one or several conditions are met. For example, if a patient attends a dental facility that is considered ¨out of network¨ certain procedures will not be covered. At other times, some procedures will not be covered simultaneously with other procedures. Some procedures will only be covered if there is a preauthorization approved, even if it is urgent. If a procedure is considered esthetic, then it will not be covered at all.
Visiting another country in order to obtain extensive dental work can have pros and cons with regard to dental insurance.
- If you do not have dental insurance, then you will be greatly benefited since the total amount paid to the provider will be very considerable.
- If you do have insurance, you will have to check if your insurance company covers treatment overseas. If it does, then you will have to pay in full for your dental work abroad and then file the paperwork to solicit reimbursement once you return home. Insurance companies require proof of payment (an invoice, voucher or receipt) and a correctly filled out ADA claim form. They may also require x-rays or doctor´s notes.
- Keep in mind Medicare and/or Medicaid do not cover dental work performed outside the United States.
The bottom line is that visiting Costa Rica will most likely free you from the restraints placed by the dental insurance, which will let you focus more on what you actually need than in what will be covered. In addition, you will make the most out of your allowed amount since fees are 50 to 70% lower than fees in the United States. At the Costa Rica Dental Team, we have everything necessary to help you fill out your claim soliciting reimbursement. Feel free to contact us with any questions with how this would work in your particular case. We like to have our patients maximize the benefits of their insurance plans.