People have a lot of expectations as to how their insurance works, but in reality, these are myths that seem to make the insurance waters even muddier. The following are the four biggest myths about dental insurance.
Dental Insurance Pays for Everything
Most patients look at dental insurance as they would their medical insurance. You meet a deductible (if you have one) and then after that, everything is taken care of. Uh-uh. That is the opposite of how dental insurance works. What we can tell you is that most dental insurance companies pay for two cleanings a year as part of their preventative care. Why? Well, if you are preventing issues, they don’t have to pay for them down the road. Smart business tactic! So, instead of a deductible, dental insurance has something called an annual maximum. This means that once you’ve used up all the money that’s been set aside, you have to pay for any other procedures out of your pocket.
FUN FACT: Dental Insurance coverage and maximums have not increased since the 1970’s!
Dental Insurance Covers Every Procedure
Some procedures, like teeth whitening, will not be covered. Dental plans are meant to help with dental expenses and that may mean only partially covering some procedures or not covering them at all. Some have limitations on how many visits to the dentist you can have in a benefits year or even limits on age! Some insurance plans limit the amount of x-rays you can get! We recommend carefully reading the fine print when choosing a dental insurance plan.
Dentists Recommend What’s Best For the Insurance Company
Insurance companies want you to believe they have your best interests at heart, but they use a lot of legalese to avoid paying for treatments or downgrading treatments. For example, you go to the dentist and he finds you have a cavity. The dentist will tell you that he needs to fill the cavity so you can keep your tooth. The dentist will fill it with a composite filling. Now, your insurance company tells you it will cover your filling 100 percent. What they don’t tell you is that they cover silver fillings 100 percent. The composite resin one the dentist will fill your cavity with? Well, you’ll have to pay the difference. The dentist uses the composite resin because of its strength and aesthetics. One of the best examples is when a crown is needed. The insurance company will cover the metal but not the porcelain. It’s these little “downgrades” that help the insurance company make a profit while denying you better treatments and services.
The Dentist Determines What’s Covered
This is quite possibly the biggest misconception out there. Your dentist has nothing to do with what your dental plan will cover. The dentist has absolutely no controlover what the insurance company pays. The insurance company and your employer’s HR department control what exactly – in very explicit legal jargon – what services they will cover and how much they’ll pay. I’m sure you’re thinking this means your employer is going to bat for you and keeping costs down, but what they are actually doing is making sure you are getting the most basic care and coverage.
Don’t let dental insurance companies fool you, they are a multinational multimillion dollar business. It’s about their profit. Call your employer’s human resources department and demand they offer you better coverage! Be familiar with your plan.