How dental insurance plans work

Many of our patients use dental insurance benefit plans, so we would like to explain why your dental insurance may not cover the entire cost of your dental procedure such as dental implants, implant overdentures or implant supported crowns or why it covers some dental procedures and not others. Most dental benefit plans are the result of a contract between your employer, union or association and an insurance company. The person who negotiates the terms of your insurance plan makes the final decision on maximum levels of reimbursement through a contract with the insurance company.

Other dental plans may want you to choose your dental care from a list of their preferred dentists. Choosing your dental care provider from this defined group can affect your levels of reimbursement. Your plan may also tell you that they will only pay dental benefits for the least expensive alternative treatment for a condition, or deny coverage for conditions that existed before you enrolled in the plan.

A deductible is the amount of dental expense for you are responsible for before your plan will assume any liability for payment of benefits and could increase your out-of-pocket expenses. In addition, many dental plans do not provide coverage for all dental procedures such as treatment of peri implantitis or sinus lift elevation. This does not mean that these procedures are not necessary – it just means that your employer has purchased a plan that does not cover the cost of providing coverage for these dental services.

If you have questions about your dental benefits plan, we recommend you contact your insurance provider or your human resources department at work.