Dental insurance is a topic that comes up often as a cosmetic and general dentist. Unfortunately, not all patients know how dental insurance works, and many let it keep them from getting the care that they need.
My hope in talking about this subject is that it will shed light on the nuances of dental insurance and help educate patients on the importance of getting the dental treatment they need – not the dental treatment that insurance will cover.
» Click here for a video version of this blog on our YouTube Channel «
- How does dental insurance work?Given that your teeth are a part of your body and contribute to your overall health, many assume that dental insurance works the same has health insurance. With health insurance, you have a yearly deductible and out-of-pocket maximum. Once you meet the out-of-pocket maximum, the insurance company will cover the cost of your care for the rest of year. This is great in the event of a catastrophe and protects you from paying exorbitant hospital bills.Dental insurance, however, is more like a coupon. Your insurance will pay up to a certain dollar amount for your dental care each year and then you must pay the rest. For patients who require extensive dental work, it’s very common to meet the maximum before even a small portion of the treatment plan is completed.The dollar amount your dental insurance will cover depends on the plan you selected and the maximum coverage for the year. However, this is only one nuance to the dental insurance market.
- Will dental insurance cover my dental care?Dental care can range from hygiene appointments to fillings and root canals, as well as cosmetic dentistry such as bioclear and veneers. However, not all of this will be covered by dental insurance. Cosmetic dentistry, for instance, is not covered by insurance because it is elective and focused on aesthetic rather than function. Something like a filling or crown may be covered by dental insurance, depending on whether the insurance company deems the treatment necessary.
- Why would my dental claim be denied?Your insurance provider will have a list of thresholds that they look at when determining whether your care is necessary. For example, let’s say a patient comes in with a cracked tooth that has a filling. We determine that a crown is the best course of treatment given their history and the state of the tooth. The insurance company may look at the size of the filling and how old the filling is and make their judgement based solely on that information.If the filling is more than 75% of the tooth and more than 5 years old – they may cover the crown. If the filling is smaller or newer, they may deny that treatment and cover another filling. However, that doesn’t mean that a crown is not needed. We see teeth like this every day that split right in half and as a care provider we understand that there is no sound correlation between the size of a filling and the risk of the tooth splitting.
- Should I receive dental care that is not covered by insurance?In my professional opinion, you should receive the dental care that your dentist – who you trust – recommends. Regardless of what your dental insurance will cover. I understand that this often comes with a hefty out-of-pocket bill, but deferring your dental needs will result in more expensive and catastrophic dentistry down the road.In our office, the goal is to get our patients to 100 with all their teeth. This is done by assessing a patient’s needs upfront and coming up with a treatment plan that addresses their needs based on priority. During this process, we do scans and radiographs and discuss the patient’s dental history. This helps us understand the cause-and-effect relationship and stay one step ahead of the problems at hand.Our office is built on trust. Having an open dialogue with patients about their dental risks and treatment plans – regardless of what insurance will cover – helps us maintain strong relationships with patients for many years.
Schedule a new patient exam
If you were recently denied coverage by your dental insurance provider and aren’t sure what to do next – call our office to schedule a new patient exam. Our team will provide a full diagnostic exam and determine the best course of treatment for you.