Written By Dr. Kyle Griffith
The team at 58 Dental is concerned for our patients and what they are experiencing with their dental insurance. The misunderstandings usually revolve around what the insurance “covers” or “does not cover.” The exclusions and limitations of dental insurance plans are often confusing, complex, and frankly overwhelming for our patients to understand. Fortunately, there is only so much that an insurance company can pack into the fine print of a dental insurance contract. Here are the top 5 dental insurance tricks that most patients are unaware of:
1)Waiting Period: This simply means that you might not be able to use all or some of your insurance benefits right after signing up with the dental insurer. Basically, the insurance company is trying to avoid paying for dental patients’ existing dental needs that were present prior to the individual purchasing insurance.
2)Replacement Clause: Dental insurances are not keen on replacing dental work that has failed prior to what they deem is a reasonable amount of time. A good example of this would be a crown that needs to be replaced sooner than would be expected. Most dental insurances will not pay for a new crown if the crown is less than 5 years old.
3)Frequency Allowances: This clause states that the insurance will only pay for a certain number of specific dental procedures in a given period of time. We see patients get frustrated with this usually regarding the number of dental cleanings an insurance company will pay for yearly. There are many instances where patients have a need to get their teeth cleaned more than twice a year. A frequency allowance may kick in and not cover the additional cleanings throughout the year.
4)Downgrading: Sometimes dental insurances are just plain stingy. A common example of downgrading is when a patient would like tooth colored fillings. Some insurances will say that the newer, better, and more esthetic option is not covered but the company will pay for the cost of older, cheaper, silver fillings.
5)Life time maximums, age limitations, and procedure exclusions: These three tricks are put into the same category because they essentially have very similar results, i.e., the dental insurance will not pay at all or will stop paying at some time. There are so many examples of this it is hard to choose but here are two common scenarios:
a.An adult patient has purchased dental insurance because they want to get braces to straighten their teeth. The insurance has an age limitation on braces that will only provide benefits up to the age of 18. Most likely the adult is over the age of 18 and the insurance will not help them pay for braces.
b.A patient purchases dental insurance to help them cover the costs of an implant to replace a missing tooth. After the insurance is purchased, the patient discovers that implants and the associated procedures are excluded from the dental coverage. The patient has purchased dental insurance for a costly procedure only to find out the insurance company will not cover anything related to that specific procedure.
Dental insurance is very complicated. It is important as a consumer to know what the restrictions and limitations are prior to making a decision about dental insurance. At the end of the day, if your decision is based upon what is best for your health rather than what your dental insurance will “pay for” you’ll be much better off. The team at 58 Dental can also help shed light on your dental insurance. Please contact 58 Dental for help understanding all of the fine print surrounding dental insurance.