April 2023 Skyline News – Let’s talk Dental Insurance


We are often asked about our thoughts on dental insurance, so we decided to devote this issue of our Quarterly Newsletter to provide guidance and advice for our patients who are interested in purchasing or maintaining their dental insurance plans.

The best resource on dental insurance is any one of our Front Office Staff members.  They will be more than happy to assist you with any questions or concerns you may have about your dental insurance options, benefits and plans.

Advantages of Dental Insurance

  • Helps offset some of the costs associated with dental treatment.
  • Is a good motivator for patients to seek regular and preventive dental care; especially if a portion of the care is covered by the plan and paid for in advance by the premiums.

Disadvantages of Dental Insurance

  • Dental plans vary greatly with each company.  The least expensive plans typically require you to see an ‘In-Network or Preferred’ Dentist which the insurance company has selected for you.  Some plans allow you to see out-of-network providers, but penalize you financially if you select a Dentist that is outside of their network.
  • Most dental insurance plans typically pay for only a portion of your treatment, and there are usually some out-of-pocket expenses.
  • There is often a waiting period before some of your benefits begin.  For example, some private dental insurance plans may not cover major or extensive treatment (crowns, bridges, implants, etc.) for 12 months and basic treatment (fillings, simple extractions, etc.) for 6 months after becoming eligible on the plan.  After the waiting periods have been met, most major treatment may only be covered at 50% and basic treatment at 80%.
  • The majority of dental insurance companies also have a low annual maximum.  After a patient has met the annual maximum, all remaining expenses are out-of-pocket for the patient.
  • Most dental insurance policies also do not cover Cosmetic dental procedures.

Our Recommendations

  • Carefully weigh the cost of your premiums against your actual dental care utilization.  For many patients who have good oral health, they may end up paying more in premiums than the actual cost of their standard cleanings, exams and x-rays.
  • If you have dental insurance, and have a large number of non-emergent and pending dental treatment, it may be beneficial for you to divide the non-emergent dental treatment into two dental plan benefit periods.  For example, if you need an implant, it would be beneficial to have the implant surgically placed during one benefit period and the restorative or crown portion of the implant completed the following benefit period to best utilize your dental benefits.  Our Front Office Staff would be happy to answer any questions you may have about maximizing your dental insurance benefits.
  • Do not purchase a dental plan which forces you to see a Dentist that the insurance company has selected for you.  You ALWAYS get better care and service from a practice which has a personal relationship with you, rather than a dental office that has a relationship with an insurance company.

The Bottom Line

As a courtesy, we are always happy to assist you by verifying your insurance coverage and billing your insurance company for your visits.  However, please remember that your insurance coverage is a contract between you and your insurance company; and our office cannot guarantee your dental benefits or how your insurance company will handle each situation.

Regular exams, x-rays and cleanings are the best way to diagnose and treat dental problems while they are still small and comparatively inexpensive to treat.  Waiting for your teeth to break or hurt is far more expensive in the long run than preventing the problems and addressing the issues while they are still small and easy to fix.  Do not put off your cleaning or exams, even if you don’t have dental insurance.

Remember to always do what is in your best interest and to not settle for what the insurance company feels is best for you and your mouth.  An insurance company will always put their bottom line and profits, ahead of what a patient needs or would most benefit from.

It’s great to have insurance to help offset and minimize costs, but trust the advice and recommendations of your dentist, more than the authorization or allowable benefits that an insurance clerk or individual has determined for your mouth.  Insurance companies often determine your allowable services, based on what is spelled out in your insurance policy; while your dentist and hygienist will make recommendations based on what they see and feel in your mouth.