Basics of Dental Insurance

Understanding Dental Insurance

For many patients, understanding their health or dental insurance policy can be a challenge. The intricacies of deductibles, co-pays, waiting periods and frequency limits can stymie the most knowledgeable. Consumers who attempt to resolve insurance problems are often frustrated by lengthy telephone hold times and impatient insurance representatives.

Health insurance is generally regarded as a necessity, though sadly, not everyone can afford to pay the monthly premiums. Happy are those whose employer provides health coverage as part of their employee benefit package. For the extremely fortunate, dental benefits may also be included; if not, the employee may be faced with the decision as to whether or not they wish to add dental coverage to their plan and pay the additional premium out of pocket.

As a newlywed whose husband did have dental insurance, I blithely assumed that insurance would cover all of our expenses. That misconception caused me endless frustration, as I was convinced our insurance company was at best incompetent, and at worst, intent on ripping us off. Years later, and with several years of experience in dealing with dental insurance providers, I am able to offer advice from both the dental and the patient point of view to those who are debating whether or not to purchase dental insurance, either in addition to existing insurance or as an individual.

As a consumer, you should first contact your dental office. Since their business office submits many claims a day, they may have an opinion about the insurance company you are considering. Find out if your dentist is a “provider” for that company. Ask about the office policy regarding insurance claims. Dental office policies range from not submitting any insurance claims, to charging the patient for that service, to submitting to any and all insurance companies and even to tracking unpaid claims as a service to their patients.

Next, study the benefits book from your insurance company. Benefits are typically categorized as preventative, basic, and major. Preventative includes x-rays, exams, cleanings and fluoride treatments. There is usually no waiting period for preventative services, which are often covered at 100%. Basic treatment varies by insurance company plans, but usually means white or silver fillings, and possibly extractions. Basic treatment may be covered at 50% to 80%, and there may be a waiting period from the date your policy takes effect of 3 to 6 months. Major treatment also varies by plan, but would include crowns, bridge work, and maybe root canal treatment. Waiting periods for major treatment could be as long as 18 months. It is good to know how your company covers for dental emergencies, and how often exams and cleanings are allowed.

Your third major consideration will be the cost of dental insurance to you personally. Here is where the rubber meets the road. Do you need extensive dental work or just maintenance? Are you better off financially to save for your dental treatment? With dental insurance you will be paying a monthly premium and a yearly deductible, as well as your portion of any treatment, and there is a limit to how much insurance will pay each year.

Most dental offices nowadays require payment at the time of service. In order for you to be mentally and financially prepared to pay your portion, your dental office can request a pretreatment estimate from your insurance company, or at the very least, give you an idea of the amount due from you at your appointment. You as the consumer are responsible for your bill. If your insurance company does not pay your claim, you are responsible for the full amount, and it is not up to your dentist’s staff to follow up with your insurance company. Many of them will, but it is not their responsibility.

That said, dental insurance is a very good thing for those who are willing to become informed about their dental coverage and work with their dental provider to use that coverage to their best advantage. Keep in mind that the insurance companies are in business to make money and it is our responsibility, as it is in all aspects of our health and welfare, to take care of ourselves.