Dental Insurance

Dental insurance isn’t technically insurance (a payment to cover the cost of a loss) at all. It is actually a money benefit, usually provided by an employer, to assist their employees in paying for routine dental treatment. An employer buys the plan based on the amount of the benefit and how much the premium costs each month. Most plans are designed to just cover a portion of the total cost. Even if your plan says that it will cover some procedures completely, this is rarely the case.

The complete coverage they refer to is usually just what the carrier allows as total payment toward a procedure, not what any dentist may actually charge. The amount that will be paid is based on what your employer has negotiated as a benefit for you; it is tied more to the premium being paid to the insurance carrier rather than actual the fee for the service you need. Because of this, most patients find that there will be an amount that insurance doesn’t cover, even when they say they are paying 100%. That amount will be your responsibility.

Most insurance plans specify how many of certain types of procedures they will cover annually. These include cleanings, periodontal (gum and bone) treatments, x-rays, and exams, as these are the types of services that many people regularly need. Since these procedures are the ones most “in demand,” the carrier limits how many they will cover. If they did not limit coverage of these procedures, the employer’s premiums would be much higher.

There are some benefit plans that require a person to select a dentist from a specific list. Usually these dentists have also agreed to a contract with the benefit plan, though these contracts have restrictions and requirements. If you choose a dentist from this list, you may pay less toward your dental care than if you choose a dentist not on the list. However, if a dentist is not on a list, this does not mean that something is wrong with the dentist or the office. It may simply mean that the dentist is not comfortable with the plan’s restrictions.

If you are wondering about your insurance coverage, a good place to start is the Employee Benefits Coordinator where you work. If you are unhappy with your insurance, or if you feel you are not getting the proper benefits, this is the best person to go to with your concerns. Most employers want their employees to receive the benefits for which they are paying. If the insurance is not paying correctly, they want to know.

Whether your insurance plan pays a little or a lot toward your dental treatment, it helps. However, do not let your benefit plan tell you what treatment you should have. Your dentist has the responsibility of recommending treatment you need, and your insurance plan has the responsibility of limiting payments.