Understanding Dental Insurance

Dental insurance is a highly complex area that creates confusion for many dental patients. The complexities of dental insurance and the lack of sufficient information provided by some insurance companies make it difficult for some patients to properly understand their benefits. We hope the following will answer most of your questions and give you a good foundation for understanding your dental benefits.

If you want to verify that your dental insurance can be used in our office (most can), please contact us. We would be happy to research your benefits for you.

What is Dental Insurance?

Employer-provided dental insurance is, essentially, a contract between your employer and a dental insurance company. The benefits that you receive are based on the contract that was negotiated between your employer and the dental insurance company, and are not determined by our dental office.

Your employer uses dental insurance as a benefit to attract employees. They must choose which benefits are necessary to provide to employees while at the same time meeting the company’s budget for insurance premiums. Because the benefits you receive are decided between your employer and the insurance company, certain services may not be covered.

The selection of covered and non-covered services is not based on what you need or want, but based strictly on what your employer purchases for their employees. Variations in policies can make understanding dental benefits difficult. Dental insurance rarely covers 100% of dental fees and, in many cases, covers below 50% or sometimes nothing at all. The percentage at which a particular procedure may be covered is based on the category in which the procedure is placed.

Most insurance companies have three standard categories: preventive, basic and major. Because insurance companies realize it is less expensive to prevent dental problems than to correct them, preventive procedures (check-ups, cleanings and x-rays) are usually covered at the highest percentage rate. Therefore, it is to your advantage to stay on a strong, preventative program to maintain your oral health. Preventative care alone means less out of pocket expense for you.

Covered and Non-Covered Services

Because of the complex nature of many dental insurance policies, some of the services you may need or want may not be covered. Our goal is to help you achieve and maintain optimal dental care. The goal of the insurance company is to sell a policy to an employer. The goal of your employer is to provide dental benefits at minimal cost to the company.

Unfortunately, because of conflicting goals, the treatment process can seem confusing. Please understand that it is not our desire to compromise your care based on insurance or employer imposed constraints.

Another fact that most dental patients do not realize is that most dental insurance plans have an annual dollar amount maximum. Once this limit is reached, no other services will be covered by dental insurance, regardless of how essential it may be to a patient’s dental health.

Also, benefits not used in a year are not “rolled over” to the following year. Our advice: take advantage of the benefits to which you are entitled before the year’s end.

How Our Office Helps

Our office will do everything possible to help you understand and make the most of your dental insurance benefits. We realize that dental insurance is complex and that it is often difficult to understand how to make it fully work to your advantage. To lessen the frustration, we are here to provide full assistance to you.

Our office will complete and submit dental insurance forms to your insurance company to achieve the maximum benefit to which you are entitled and will work diligently to expedite the process. Please be aware that some dental insurance companies take longer than others to complete payment.

Pre-Determination Policies

Some insurance companies require a pre-determination of benefits for more extensive treatment plans. Like you, we recognize that the pre-determination process is often time-consuming and may prolong the completion of necessary treatment. However, we do recommend it for some patients.

Our office will do everything possible to help you maximize the insurance benefits to which you are entitled. In most cases, we are able to begin treatment prior to receiving a pre-determination from the dental insurance company.

However, it is important to understand that in the event that your dental insurance company denies benefits, you are responsible for services rendered. Naturally, we are able to provide you with an estimated treatment plan that will outline the fee for proposed treatment, your estimated portion and the estimated insurance benefit.

Elective Treatment

Some services (ie. cosmetic dentistry) are typically not covered by dental insurance companies. Sometimes, insurance companies may pay at a lower percentage rate for select services such as implants and mouth guards. Although these procedures are important dental services that may greatly enhance quality of life, they are rarely included as benefits in your employer’s policy.

Our Philosophy

We recognize that dental insurance is complex. We pride ourselves in providing the highest quality of care for every patient. Therefore, our office remains dedicated to assisting you with maximizing your benefits. Please let us know if you have any questions. It will be our pleasure to help you.


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