Why Doesn’t My Dental Insurance Cover The Treatment That I Need? Does My Dentist Charge Too Much?

That’s an easy question to answer. It is because dental insurance is not insurance in the traditional sense. The best way to think about dental insurance is that it’s a rebate. With all dental insurance there are several guidelines that apply to almost every plan.

  1. Most dental plans are purchased by employers and not individuals. Most companies look for low cost options. Low costs mean lower coverage for you.
  2. All plans have annual maximums and the average is $1000. There are exceptions.
  3. Dental insurance is different than medical insurance. Medical insurance is good for big procedures like hip and knee replacements and even heart surgery. Dental insurance is good for small procedure and not for big expensive procedures. Dental insurance was designed to pay for small procedures on otherwise healthy people. It is good for tooth cleanings, routine x-rays, fillings, a crown or even an extraction. That $1,000 allowance was never designed to pay for care to rehabilitate your mouth. It was designed for people that needed minimum care.
  4. Most treatments are not covered at 100% or even 80% but at some secret percentage that varies from company to company and from geographic region to region. That means that your company will pay more for the exact same procedure that is done in Philadelphia Pa than is done 300 miles away in Pittsburgh. So, if your dentists charges $100 for a procedure the insurance company may decide to pay 60% of $80 in Philadelphia and 60% of $7o dollars in Pittsburgh  and not the $100 charge for reasons that they will make up to suit their bottom line because they want to pay out as little as possible. Each year this number is being reduced to increase their profit margins and decrease reimbursements to you and to your dentist.
  5. The premium that your employer pays for your plan is very low cost and since the cost is low they have $1000 maximums in place for a very good reason: ”There is no such thing as a free lunch!” The $1,000 maximum has been the same since around 1975 and has not kept up with inflation. The average cost of dental insurance is $45 a month. If you need an extraction and an implant and a tooth on top of the implant you will most likely get your $1000 towards the cost of your treatment and the rest will be out of pocket. If your plan excludes certain procedures, and many do, you may not even get the $1000.

The bottom line is this: If your employer provides dental insurance as a benefit it is a bonus. Most people have unrealistic expectations about what “dental insurance” is and what it should provide. Certainly, maximize the benefit and realize that any procedures that you need will most likely require additional out of pocket expenses.

You are the one that must determine the quality of life that you desire. We are living to 80 to 100 years these days and quality of life is critically important. Every birth, every funeral, every wedding and birthday celebration revolves around food and being able to laugh, chew, taste and enjoy that food. That can only happen if you have real teeth. The quality of your life…the life in your years is as important as the years in your life. You must be the one to make the decisions that will affect you for the rest of your life and not the insurance company, so make those decisions very carefully. If you don’t care about the quality of your life…who will?

Live long- Smile big -Eat well.

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