Dental insurance, whether it’s paid for by you or your employer, allows you to use a fixed number of dollars per year for dental care. It’s like a gift card that expires at the end of the year. If you have a dental need for this allotted money, it can literally pay to know your policy. You or your employer chose this policy for you and it is a benefit you may be leaving on the table each year. It’s like walking away from two days of paid vacation! Now, I am not advocating unnecessary dental treatment just to use your benefits, but if you have a need for it, make a plan to use it. According to a Cigna study, twenty-five percent of people with dental coverage do not use the yearly benefit for preventative care.
Most dental insurance policies have an annual maximum ranging from about $500-$2000 or so. In addition to this maximum, most policies put a percentage on what they will cover for each type of procedure. Say 100% for preventative (cleanings and exams), 80% for direct restorations (tooth-colored restorations applied directly to the tooth), and 50% for indirect restorations (crowns and onlays). This varies widely from policy to policy. If your policy pays 100% of your dental cleanings twice per year, why wouldn’t you take that benefit? In addition to this, some policies now have incentives to take care of your teeth. If you visit your dentist twice per year, the coverage for preventative procedure s increases from 70% to 80%, increasing by 10% each year until it reaches 100%. Why would an insurance company do this? Because they know that well cared for teeth have significantly less problems. They also know that the earlier you catch dental disease, the more conservative the treatment will be, both clinically and financially. This also benefits you. If your policy covers 50%-80% for a restorative procedure to treat decay, wouldn’t you want to find it when it is less costly to treat?
Be aware that most insurance companies have a table of what they term “usual customary and reasonable” fees. These fee tables are used for medical and dental policies and change with each zip code. These fee tables are used to limit what companies pay out. This amount can be less than what your provider charges for a procedure. It does not mean the provider is charging too much. It is more about the insurance company limiting what it pays out. Insurance companies usually do not publish this information and it can be difficult to find out. This is why medical and dental treatment plans are labeled as “estimates” of what your insurance may pay for a specific procedure.
So, look over your policy. You can find a copy of your benefits on your insurance company website. You can ask your HR representative to supply one for you. You can also ask our front desk team for help. The relationship with your insurance company is with you and not us, but we are willing to help you navigate it. We have lots of experience. If you have a need for your benefits, be sure to use them!