1. How do ShelterPoint and DenteMax work together?
ShelterPoint Life is your insurance carrier, providing you with a quality Dental
Care plan. DenteMax is a network enhancement to your underlying dental coverage
from ShelterPoint: participating dentists have accepted a fixed, lower rate
schedule of fees when receiving payment for their services. DenteMax links dentists,
patients, and providers together. Your Benefit Plan Administrator can explain your
specific benefit levels and fees
2. How can I find a participating dentist?
Simply follow this link to the DenteMax
website and search for a location that’s convenient for you.
3. How much can I save if I choose a DenteMax dentist over a provider who is not
in the network?
DenteMax dentists have agreed to accept fees with an average 25-40% below usual
charges. So your out-of-pocket expenses may be reduced.
| Non-Network Dentist
|
| DenteMax Dentist
|
|
| Dentist’s fee
| $850
| Dentist’s negotiated DenteMax fee
| $600
|
| Allowable charge
| $800
|
| Co-insurance
| 50% of allowable charge
| Co-insurance
| 50% of negotiated fee
|
| Policy pays
| $400
| Policy pays
| $300
|
| You pay
| $450
| You pay
| $300
|
In this example, you save $150 using a network dentist!
This is an example. Dollar amounts in this chart are for illustration only. Actual
charges may differ from this example.
4. What do the numbers for in-network co-insurance mean?
These numbers indicate how much of the network dentist’s negotiated DenteMax fee
for a specific procedure is covered by the policy. Let’s assume, for example, you
choose a 100-80-50 plan: The first number always shows the coverage percentage for
preventive services – in this case 100%. This means that preventive services are
fully covered and that you don’t incur any out-of-pocket expenses. The second number
indicates the coverage percentage for basic services, and the third number refers
to major services. So, if the co-insurance is set at 80%, for example, your policy
covers 80% of the participating dentist’s negotiated DenteMax fee for the particular
procedure. And you pay the balance between the covered amount and your dentist’s
bill.
5. How does the co-insurance work for out-of-network providers?
Out-of-network co-insurance works similarly to in-network co-insurance. However,
if you receive services from a non-network dentist, the co-insurance numbers indicate
the covered percentage of the maximum allowable charge for a specific procedure
in your area – not the negotiated fee of a network dentist. Let assume that dentists
usually charge $800 for a particular major procedure in your area and that your
dentist bills you $850: The co-insurance under this policy pays based on the maximum
allowable charge – $800 in this case. So, if your co-insurance is set at 50% for
a major procedure, the policy would pay $400. And you would pay the balance between
the covered amount and your dentist bill, which is $450 in this example.
6. How do I submit a claim?
7. How can I check the status of my claim?
To check the status please visit www.readysetdental.com
Phone: 516-82908100https://www.shelterpoint.com