Dental Insurance Plans 101

Visiting the dentist is one of the many responsibilities we take on to stay healthy. It’s up there with visiting your doctor at least twice a year, making time for exercise, and brushing your teeth. Maintaining a modern healthy lifestyle isn’t free, but you can build your life in a way that makes it easily possible. Insurance plans are built to help professionals and their families take care of their regular health needs by preparing for emergencies and making it easier to afford preventative care.

However, anyone who’s ever looked closely at their dental plan knows that the policies aren’t always as clear-cut as they seem. Insurance surprises are almost never a good thing. Today, we’re here to lay out the basics of dental insurance plans in the US that any professional or family can use to make sure their dental needs are covered.

Expect a Co-Pay

Dental insurance plans are almost never designed to cover the full cost of dental care. It’s built to be supplemental to help you pay for yearly dental care, not to cover you entirely. Expect to pay a percentage of the cost for each visit, or for your yearly total. There may also be an annual cap on how much dental insurance you can receive.

If you do have a cap, that cap will be less than whatever your employer is paying in for the insurance plan. Remember, the insurance company only makes a profit by the difference of what they are paid to what they pay out.

Know your policy. And expect to pay a larger percent than was advertised. The phrase “up to __%” means that it’s probably well below, but couldn’t possibly go above that percentage that the insurance company will pay.

Always Confirm Procedure Coverage

People are always surprised when small preventative procedures or common dental treatments are not covered by their insurance. This can include things like extra cleanings or tooth-colored crowns. The insurance companies did a formula 10 or more years ago ‘defining’ what minimum health coverage would look like and likely haven’t updated since. They may allow only for the cost of now-rare silver amalgam fillings instead of modern tooth-colored plastic. Or they’ll cover regular cleanings, but deep preventative cleanings are on you.

Always, always, always confirm whether or not a procedure is covered by your insurance. Even if you decide to go ahead without coverage, no one likes a surprise with a price on it.

The Dentist is On Your Side

Dentists dislike jumping through insurance hoops as much (or more!) than you do. Understand that as dentists, we just want to help patients keep their teeth clean and get the best treatments for each situation. It’s just as frustrating for us when the insurance company denies a procedure or puts bizarre restrictions on your choices.

It’s unfortunate, but patients often get mad at their dentists and dental staff when insurance gets in the way. Please know that we’re on your side. Talk to your dentist and their staff about how to get the best out of your insurance, or what to look for in a new dental insurance policy.

You Always Have a Choice

Finally, we’d like to point out that the insurance companies don’t actually have the final say. You don’t have to limit your choices only to what insurance will cover.  And if your dentist says you need a solution that the insurance company doesn’t cover, don’t put yourself in danger because of an insurance company policy.

If your insurance company has “preferred” dentists but you don’t personally prefer them, you don’t have to go to them. Chances are that procedures will be covered elsewhere, they just won’t be as cheap.

And never forget that you have a choice of insurance providers. This may seem like something set in stone but if an insurance company is consistently treating you poorly, you have every reason to make some changes to get the coverage you need. This is especially true if you are being subjected to policies like down-coding claims to make you pay more out of pocket at the last minute.

Dental insurance can be a breeze with the right provider and plan for your needs, or it can be a bit more complicated. Why not work with your dentist to determine what your needs are and how your current coverage can be worked to accomplish that. For more dental insights or to make an appointment, contact us today!

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