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Part 2: The Newest Challenges with Dental Insurance

July 23, 2013

Filed under: Uncategorized — admin @ 1:31 pm


As employers cut the dollars available for dental coverage, the insurance companies are coming up with creative ways to decrease benefits.  Some of the challenges we are starting to see are:

  • Insurance considers x-rays at the basic level of coverage versus the preventive level, so the patient has to pay a deductible and a certain percentage on x-rays which historically were covered at 100%.
  • Insurance “downgrades” things like porcelain crowns on back teeth or tooth colored fillings on molars, causing the patient to pay more out of pocket.(Most dentists don’t even do silver fillings anymore!)
  • Even when a pre-determination is sent, insurance doesn’t reveal how they will actually pay once the procedure is completed and a claim sent, causing surprises for the patient after treatment.
  • Insurance determining a minimum age for x-rays even though a dentist is legally responsible for what is in their patient’s mouths and the conditions that exist.
  • Insurance only paying for an “alternate procedure” because it is the less expensive way to go, but not necessarily best for the patient’s oral health.

At Long Family Dental, we have experienced all the above and more!  We do our best to give our patients an estimate for their dental treatment, but as you can see, it is challenging.  Unfortunately, patients don’t understand why the estimate we give them is not always accurate.  There are over 1,000 dental codes and it would be impossible to go through each one to find out the coverage and any restrictions individually.  And, every time a call is made to the insurance company, there are multiple warnings that the information is not a “guarantee of benefits” and may have limits and exclusions that are only revealed once a claim is filed.

Oral health is an important part of a person’s overall health and many people do not realize how the conditions in their mouth can affect other areas of their health.  Our doctors continue to stay abreast of the latest information and research in dental technologies, dental products, procedures and treatments so we can confidently promote optimal oral health.  It is discouraging when a patient makes a decision about their dental treatment based on whether insurance will cover it or not, and even worse when a patient becomes upset with the dental office because their dental plan has unique benefit restrictions or limits and exclusions.

Patients should continue to look at their dental insurance as a supplement to their oral health.  As the insured, you may be able to find out more about your policies limits and exclusions, but it is our hope that you will still consider what is best for your oral health.  This information can only come from your dentist, not your insurance company.

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