Unhappy With Your Dental Insurance Coverage?

Get More Out of Your Dental Insurance

Dental insurance works very differently than what you’re used to with medical insurance coverage. If you’re frustrated with your dental insurance policy, you’re not alone. In this short article, we will shed some light on how dental insurance works and how to maximize it to your benefit.

3 biggest differences with dental insurance plans:

  1. Dental Insurances today are really designed to cover your child’s dental preventive care and not your dental treatment needs. Today’s typical policies cover cleanings, exams, and x rays between 80-100%, whereas, they cover crowns or implants at 0-50% most commonly. 
  2. The greatest majority of dental insurance policies (PPO) have to give you the option to pick your dental provider of choice. However, some dental insurance companies will try and mislead you into being seen by their preferred network dentists. These “in network” dental providers have signed contracts which are designed to save the insurance company money, typically at the expense of the patient’s pocket and or health. It does not mean you have better dental coverage.
  3. Typically, you are given a fixed maximum dollar amount that your dental insurance policy will cover. So if you end up with no dental treatment needs, or end up needing $10,000 worth of treatment, your dental insurance will cap what they pay at a fixed number. That number is typically $1500/yr and has been the same number since dental insurance was born in the 1950s.  Of course healthcare costs have skyrocketed in the last 6 decades, but dental insurance maximum benefits have not been changed to adjust for increased cost of living. 
woman with questions about her dental insurance

How to Maximize Your Dental Insurance Coverage:

1- Pick the right pediatric dentist. That pediatric dental provider may not be the one recommended by your insurance. After all, the insurance company has their stockholders' interest in mind before your child’s oral health. There is such a thing as over treatment, and such a thing as under treatment. Neither is the ideal approach.

How do you know if you picked the right dental provider for your child's dental needs? 

Don't be shy to ask questions, self educate, and or even get a second opinion. Then, use your gut feeling. A trusted dental provider will recommend and provide the dental treatment that they would offer their own child; no more, no less. This means, they would definitely have your child’s oral health as the priority, not the dental insurance company’s contract.

2- Stay ahead of costly dental treatment. Since routine preventive care is typically covered at a much higher percentage (80-100%), you are smart to use those dental services. For example, if your pediatric dentist places sealants on your child’s permanent molars, that is typically covered at 100% and they reduce the risk of needing dental fillings, which would be out of pocket at 80% in the future. Other preventive dental procedures such as fluoride treatments and Conservative Resin Restorations can save you money in a very similar way.

3- Ask your pediatric dental office to pre-authorize the recommended dental treatment plan. This minimizes the chances of you being surprised with a bill due to dental coverage limitations and games (such as frequency, max allowable fee schedule, age limits, waiting periods etc...) placed by the dental insurance company.

Hopefully this article gives you a little glimpse into the intricacies and complications of dental insurance plans and coverage. You can also read this article on how to maximize your dental insurance benefits at the end of the year before they expire, it’s what we in the dental industry call “Use it or lose it”.

If you have a question about your dental insurance and coverage, we have a team of highly trained staff that are always willing to answer and offer suggestions and advice. You can call us: (858)693-5677

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