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Navigating the World of Dental Insurance Terminology

Unless you work for an insurance company, you probably do not spend a lot of your time studying all the terminology that dental insurance companies use to describe the treatments and services they cover. If it seems pretty confusing, here are some of the most commonly used dental insurance terms and what they mean.

A Basic Glossary

Annual Maximum–The maximum amount your policy will pay per year for care at Hayes Family Dentistry. It is often divided into costs per individual, and (if you are on a family plan) per family

Co-payment– An amount the patient pays at the time of service before receiving care, and before the insurance pays for any portion of the care

Covered Services– A list of all the treatments, services, and procedures the insurance policy will cover under your contract

Deductible– A dollar amount that you must pay out of pocket each year before the insurance company will pay for any treatments or procedures

Diagnostic/Preventive Services– A category of treatments or procedures that most insurance will cover before the deductible which may include services like preventive appointments with Dr. Kevin Hayes and Dr. Sandy Hayes, X-rays, and evaluations

In-Network and Out-of-Network– A list of providers that are part of an insurance company’s “network”

  • If you visit in-network providers, the insurance company will typically cover a larger portion of the cost of the care you receive. If you visit someone who is not part of the network, known as an out-of-network provider, the insurance company may pay for a portion of the care, but you will pay a significantly larger share from your own pocket.

Lifetime Maximum– The maximum amount that an insurance plan will pay toward care for an individual or family (if you have an applicable family plan)

  • This is not a per-year maximum, but rather a maximum that can be paid over the entire life of the patient.

Limitations/Exclusions– A list of all the procedures an insurance policy does not cover

  • Coverage may limit the timing or frequency of a specific treatment or procedure (only covering a certain number within a calendar year), or may exclude some treatments entirely. Knowing the limitations and exclusions of a policy is very important.

Member/Insured/Covered Person/Beneficiary/Enrollee– Someone who is eligible to receive benefits under an insurance plan

Provider– Dr. Kevin Hayes and Dr. Sandy Hayes or other oral health specialist who provides treatment

Waiting Period– A specified amount of time that the patient must be enrolled with an insurance plan before it will pay for certain treatments; waiting periods may be waived if you were previously enrolled in another dental insurance plan with a different carrier

There are many different insurance options available, so you need to find out exactly what your insurance covers. It’s important to review your plan with a qualified insurance specialist. Don’t be afraid to ask questions about the policy so you can understand it fully and be confident that you know everything your policy covers the next time you come in for treatment at our Cookeville office.

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patient testimonials

"I had multiple bad experiences as a child with the dentist. As a result, I have feared going to the dentist office for years. Dr. Kevin and Sandy are so gentle and caring that I still bring my children to them and we live almost two hours away!" ~ Tasha W.

patient testimonials

"Since age 7, I have been extremely fearful of going to the dentist. It was this age that I was told by a previous dentist that I would eventually have to have a root canal and my front tooth capped due to a bicycling accident. This gave me a scary image and sounded painful. When Dr. Sandy told me a root canal was needed, although it was 18 years later, it still sounded scary and painful. Then I was told about sedation. The entire day of the appointment I don’t recall much. When I woke up, the "scary" part was already over and I felt refreshed with zero pain or discomfort. I was completely satisfied with my smile and the results! As for the staff, each person I was in contact with was excellent in accommodating each need that I had and made me feel like I was a part of their family. I would 100% recommend Hayes Family Dentistry and sedation to anyone. The entire experience was, in one word, amazing!" ~ Kellie A.

patient testimonials

"No pain was felt. New found respect for dentistry. Recovery was a lot easier. Would not see any other dentist. Would recommend Hayes Family Dentistry to anyone and everyone. Very, very pleased with my experience and even brought my wife here. All I can say is WOW!" ~ Jason R.

patient testimonials

"I have been extremely afraid to go to the dentist. I had a bad experience about three years ago where my jaw got locked open during a procedure. For about an hour they had to do warm moist compresses and massage my temporal joint to get my jaw unlocked. I was extremely sore for about three and a half weeks. This created a fear of going back to the dentist. My experience with sedation: when I came in that morning I was not anxious about the appointment because I took a pill that morning that helped calm me. I was greeted, they got me comfortable, and I watched a pleasant video about ocean life. I don’t remember anything about that appointment. My next memory was of waking up refreshed and ready to go the next day. I didn’t have any soreness and didn’t have to worry about what I ate because of my joints being sore. It was the most pleasant experience I have ever had at a dental office. I will definitely have sedation again for any kind of future treatment." ~ Sara H.

patient testimonials

"Are you afraid to smile because you’re ashamed of your smile? Hayes Family Dentistry can help. Are you saying, “But I’m more afraid of going to a dentist than people seeing my smile?” Hayes Family Dentistry can really help; they helped me. Being afraid of the dentist is nothing to be ashamed of—it’s called dental phobia and you’re not alone. A lot of people suffer from it. But now thanks to sedation dentistry, you don’t have to suffer anymore." ~ Tony "Gator" Harrison
(Formerly with Country Giant)

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We love to give back to the community

We love to give back to the community in which we live and work. We provide educational presentations to local preschools, organizational groups like the boy scouts and church programs. Especially rewarding is our involvement with “Teen Challenge” and “Smiles from the Heart.” We are passionate about helping people who may be less fortunate or find themselves in difficult situations.

Hayes Family Dentistry, PC