How Dental Insurance Really Works

While we are very happy to help utilize dental insurance in our office and process the necessary paperwork, there seems to be a common misunderstanding.

Dental insurance is YOUR insurance. Dental insurance does not care.

We do our best to know how your plan works, but as a consumer it is necessary for you to be familiar with your plan. There are thousands of dental plans out there and subgroups as well. Employees in adjacent cubicles can have the same plan but different benefits. It is confusing and we try to help, but it is impossible for us to predict with 100% accuracy what they will cover 100% of the time (we are good and usually ARE correct, but sometimes the insurance companies do what they do…).

As the economy fluctuates, we see some plans reject claims that they covered in the past. The person most qualified to suggest treatment is the doctor that actually LOOKED into a person’s mouth. If an x-ray was all that was needed, dentists wouldn’t need to even look inside of a mouth.

An example was a tooth that had a very large filling and decay all around the filling and cracked enamel. The recommendation was a crown, yet the insurance company refused to pay, saying it was fine. No matter how many photos and x-rays were sent, they just wouldn’t pay. That doesn’t mean the care given was not appropriate. It simply means the insurance company chose not to pay based on the opinion of their minimum wage desk clerk, or occasionally their contracted dentist that gets paid based on how much money is NOT spent. The insurance company is designed for nothing more than to make money. They make their money by NOT spending it. They deny claims for their own profits, and the subscribers (patients) suffer as a result.