Whether you’re currently without dental insurance or are shopping around for a new policy, the process of searching for your ideal policy is time consuming. You’re required to pay for it every month, but most people are unsure how dental insurance plans work. As a result, many patients overpay for treatment.

Dental insurance is different from a traditional health insurance plan. Dental Insurance covers a specific preventative care. While shopping for a dental health plan, here are a few important considerations to keep in mind.

1. Dont Wait

Don’t procrastinate by putting off making a decision until you absolutely need dental work done. The sooner you’re covered, the better. Most dental plans have a waiting period for major services. During this waiting period, you may not be covered for certain types of dental work. The worst thing you can do is to wait until something bad happens to get coverage.

Get Exams and Cleanings Regularly!

The best way to maintain good oral health is to go to your dentist at least twice a year for an exam and cleaning.  These services are covered 100% by your PPO (Preferred Provider Organizations) plan. Problems detected early require less costly treatment to repair. Always practice good oral hygiene and follow your dentist’s instructions for maintaining oral health.

2. Watchout  for the “Lowest” Plan

Everybody’s needs are different when it comes to dental insurance. Find a policy that meets your needs, and avoiding paying for things you won’t need. Don’t always go with the least expensive option. A lower cost plan may not have important provisions that are easy to overlook. The benefits in different types of dental plans can vary.  Take your time to evaluate whether the plan pays benefits when visiting an out-of-network dentist.

Understand Your Plan

Dental insurance is a tool to help patients with the costs involved in maintaining good dental health. It is important to understand the provisions and limitations of your dental plan. Dental plan documents can be boring and time consuming, but you should do it before using your plan benefits.  It is not the responsibility of the insurance company or the dentist office to pay for the services rendered. Understanding your plan and how it works, makes it far less likely to end up with claim denials and unexpected dental bills.

3. Deductibles and Co-Pays

No matter what kind of dental plan you choose, you’ll be paying some kind of deductible and/or co-pay when you see the dentist. Many plans provide coverage for bi-annual exams, most plans don’t cover 100% for other dental work, for example:

  • cavity fillings
  • tooth extraction
  • dental crowns

4. What’s Covered (and What’s Not)

Before you decide on a dental plan, it’s always recommended that you read the fine print to get a true picture of what’s covered by your plan and what’s not. Preventative exams, cleanings, and X-rays ought to be covered, but certain procedures such as cosmetic work will be paid for out-of-pocket.

Ask for a “Pre-Determination” of Benefits

Most dental work is not an emergency.  There is usually some time in between when the treatment is recommended by the dentist and when the treatment is actually performed.  Ask your in-network dental provider to send a “pre-determination” of benefits to your insurance company before proceeding with treatment.  The insurance company will process the estimate just as it would an actual claim for services.  The difference is,  instead of sending a payment, the insurance company will send a statement showing exactly what they would have paid on an actual claim.  This is the best way to get the most detailed information possible before having an extensive treatment.

Read Your Explanation Of Benifits

An Explanation of Benefits statement is provided to both the dentist and the patient every time a claim is paid or denied.  Make sure to read it, understand it and compare it to your itemized receipt for services provided by the dentist. Make sure the plan has paid your claim correctly.  If charges were unpaid or denied, find out why.  Don’t pay for services not paid by your insurance without first calling the insurance company and finding out why the payment was denied and what you can do to get it paid.

5. Your Preferred Dentist

Make sure the policy you choose is accepted by your preferred dentist. If not, find out how the plan covers benefits for going “out-of-network”. Verify whether your dentist is in-network by viewing the provider listing for the plan on the insurance company’s website and by contacting the front desk staff at your dentist’s office.







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