You’re not alone! Dental insurance can be a complicated system to navigate. Our team can help make your insurance terms and conditions a bit more user-friendly—and our insurance specialist will provide you with a complimentary benefit analysis if you’d like. There are questions about dental insurance that we hear frequently, and we give some answers to (and advice about) those questions below. If you have questions or concerns about dental insurance, don’t hesitate to get in touch with us today!
Dental insurance is handy for coverage of routine checkups and hygiene if it is being provided by your employer without cost to you. If you are paying out-of-pocket dental insurance premium costs, we advise you to investigate flexible health savings account options with your employer, as this will be a wiser financial choice for you.
Dental insurance is a contract between you, your employer and the insurance company, who allows you a set annual amount to use in whatever manner that company sees fit. Dental services are assigned levels of coverage depending on the individual subscriber’s plan.
Many insurances will cover 100% of twice-yearly cleanings, checkups, and necessary x-rays, but coverage then drops to 80% of the total cost of a filling or 50% of the total cost of a crown. The annual insurance allotment is paid for by monthly premium, and subscribers also must meet an annual deductible, which means they will pay out of pocket until the deductible amount is reached (i.e., $1,200) before the coverage for anything beyond the fully-covered services begins to kick in. There is also a plan maximum limiting the total amount of coverage available for subscriber use in a calendar year. (This is why people will opt to have certain procedures immediately but pause treatment to wait until January 1 of the next calendar year arrives to make the most of their available coverage.)
Contracted or in-network dentists enable insurance companies to keep a tighter rein on their own costs. These dentists provide the most cost-efficient treatment for the insurance company, which often means a quick fix rather than a long-term solution. Your oral health? Not part of the equation.
Insurance companies are in business to make money—period. They employ people with fancy business and management degrees who are very skillful at manipulating words and who write policies that make it sound like “the insured” (that’s you) will save money by seeing an in-network (contracted) dentist.
While that may seem true in the immediate moment of side-by-side comparison, bear in mind that the most pressing concerns for any insurance company are their shareholders and their bottom line—not your oral health.
“Exception” and “limitation” are very popular words in Insurance Policy World. For example, you may have started a new job six months ago and go to the dentist to see about an implant to replace a tooth that’s been missing for a while. Many insurances will deny coverage for that implant because the tooth was missing before you subscribed to their plan, which they consider a preexisting condition.
Other common reasons a dental insurance claim may be refused include:
Keep careful records of your dental treatment paperwork and insurance communications. If you feel one of your claims was refused in error, don’t be afraid to ask the insurance company questions. Take detailed notes of any phone conversations and save or print emails until your claim is resolved. Insurance companies have appeal forms and processes to accommodate situations like this. They are human, and they do make mistakes!!
We accept all insurances except Medicaid and Medicare. The only insurance company we are contracted with is United Concordia.
If you need any significant amount of dental work done and are seeking long-term solutions rather than cheap, immediate fixes, it may be in your best interest to choose an out-of-network dentist. Choosing an out-of-network dentist may increase the likelihood of unbiased assessment of your individual dental case and a solid ongoing treatment plan. We don’t contract with most insurance companies precisely because we want to provide assessments, plans, and exceptional treatment that will best benefit each individual patient. You are the most important part of our practice and the reason we’re here!
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