Employers will often offer dental benefits to their employees in order to reduce their overall costs of care. By taking advantage of preventive care coverage, you can protect your smile for many years to come as well as reduce long-term costs associated with dental procedures. With that said, it’s important to recognize the details of your plan and how insurance generally works.
Our role as a dental provider is to identify potential or existing problems with your oral health and make recommendations on how to resolve them. Conversely, your dental insurance company does not make payment decisions based on your needs but rather based on a coverage table in a contract that is not customized for you as an individual. This means that, at times, the dental care you need may not be covered by your policy. We will always do our best to help get you the most out of your dental insurance as possible, and in the end, it will always be your decision as to whether to proceed with treatment. And it goes without saying, but we will never try to sell you on services that would not be beneficial to your oral health.
It’s important to note that dental insurance is very different from medical insurance plans. While medical benefits are usually used to cover emergency injuries or illnesses, dental insurance is meant to be used on a routine basis. This means that preventive services, such as exams, dental cleanings, and xrays, are generally covered at a higher rate than restorative services, including dental fillings, crowns, and bridges.
Every plan is going to have its own unique stipulations that dictate the type of coverage you receive for care. However, most plans tend to use a 100-80-50 coverage system. This refers to the following structure below:
For example, an insurance company may say that fillings are covered at 70% (leaving you responsible for 30% of the cost). However, they may only cover 70% of what a silver mercury filling would cost, not 70% percent of what a tooth-colored filling would cost. This means that when we place your tooth colored filling, you would owe 30% of what a tooth-colored filling would cost plus the difference between 70% of the cost of what a tooth-colored filling costs and 70% of what an amalgam filling costs. We know it’s confusing- we’re here to help.
In general, your benefits are an agreement between your employer and the insurance company; as the dental provider, we do not get any input on what your insurance plan does or does not cover. If you have questions about your insurance, we are happy to try to help clarify your benefits. However, you can also contact your HR department for further clarification about your specific plan, since it was your company that chose exactly what your insurance benefits will cover.
Not sure if we accept your plan? We likely take it! Reach out to our team today to learn more.