What’s the Best Dental Insurance?
This is one of the most common questions we get asked in the front office. Picking the correct insurance can save you money and headache. If there were a way to prevent getting a ticket wouldn’t you want to know? We may not be a traffic ticket lawyer, but we know know a thing or two about dental insurance. So let’s take a close look and see if we can get a better understanding.
Employer provided vs. individual policies
If you have insurance through your employer, it is the employer who is deciding what procedures are covered, at what percentage each procedure is covered, the amount of the deductible that you pay toward applicable procedures, and the amount of benefits provided each year (also known as the yearly max).
In that regard, dental insurance is really more like a prepaid benefits plan, not “insurance” per se, and there is no simple answer as to what is the best dental insurance. And for those who have individual dental policies not through an employer, you really have to look at what is and isn’t covered and at what percentage, etc.
Understanding your plan is more important than who your insurance company is.
Knowing what, if anything, is “downgraded” is very important. Sometimes dental procedures like fillings or crowns are “downgraded” by your insurance company. This is also referred to as an “alternate benefit.” Many plans may downgrade your fillings to amalgam (or metal) fillings. Many modern dental practices, including our office, no longer place metal fillings. So for plans with downgraded fillings, the insurance will cover the fee for an amalgam filling, and you will pay the difference between the white versus metal filling fee.
Your plan doesn’t know your personal dental needs
As far as what your particular plan covers and what it doesn’t, a very important thing to keep in mind is that this has no clinical bearing whatsoever. Your employer doesn’t know what treatment is best for you clinically, nor does your insurance company—only you and your dentist know this.
If you decide to only do the procedures that are covered by your insurance plan, it can negatively affect your treatment in a variety of ways. Therefore, patients should make informed choices with regard to their dental health, not let their insurance plan determine the treatment.
Make informed choices
- Ask lots of questions from your dentist
- Be informed about what caused the condition
- Understand the treatment goal
- Find out if there are any alternative treatments available
- Know the consequences of not doing anything
Common problems with insurances
Nightguards, for instance, are something your insurance plan may not cover. Nightguards are plastic trays that fit over one arch of your teeth, usually the top arch. Your dentist may recommend one if you grind your teeth at night. They are often also recommended if you’ve had any implants or veneers, to protect the teeth that you’ve invested in.
Tooth-grinding, or bruxism, can cause headaches, jaw pain, tooth pain, and problems with your occlusion (how the top and bottom teeth fit with each other) as well as irreversible loss of the enamel of your teeth. In certain cases, not getting a nightguard could lead to these types of problems or a worsening of these problems.
Another way in which your insurance plan can adversely affect your treatment deals with frequency. A majority of policies will only consider replacing a crown every 5 or 10 years. So say you’ve had a crown done a year or two ago, if you and/or your dentist determine that the crown needs to be replaced, insurance will not cover the cost of replacing the crown no matter how valid the reason for replacement. The same thing goes for fillings, the frequency limit typically being 1-3 years.
Dental care is an investment in your oral health. You should look at what is best for you, not what your insurance covers. If you are determining what procedures to do based on what your plan covers, you’re doing yourself a disservice. If you’re not satisfied with your dental coverage through your employer or you think it’s inadequate, let your employer or your Human Resources Department know. If they are informed and aware, they can make better decisions regarding your plan.