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Dental Insurance Terms

Dental insurance provides wonderful benefits. However, there are numerous confusing provisions in the “fine print” of most contracts. Some common terms to know & understand:

  1. Diagnostic: Exams, X-rays, simple cleanings – usually covered at 80-100% of the insurer’s fabricated fee.
  2. Basic: Fillings, Root canals- usually covered at 60-80% of the carrier’s assigned fee.
  3. Major: Crowns, Bridges, Dentures, Gum treatment- usually covered at 0-50% of the artificial insurance fee.

Common Questions About Dental Insurance

1. How does dental insurance work?
Dental Insurance will help pay for SOME of your dental needs. The more your employer paid for coverage, the better your plan will be. Whatever your benefits, they are a wonderful gift to have.

2. How are plans different?
Most plans have co-payments, deductibles, maximums, and excluded services. Please refer to our “Dental Insurance Terms” section, for explanations & examples of these confusing features.

3. I reached my maximum in no-time. Is that normal?
The common $1000-$1500 maximum was set 50 years ago as a “reasonable” level of dental coverage per year & has not increased since. Many people need care that far exceeds this artificial maximum.

4. If I don’t have coverage, it must not be necessary – right?
No. Your insurance contract is designed by lawyers and financial experts to control costs. The limitations of your policy have no relation to the treatment that you need or want.  It is your dentist’s responsibility to advise you what treatments are available and what is best for you.

5. My insurance will pay only for a cheaper treatment. Should I get that instead?
Insurers commonly pay for the “least expensive alternative treatment.”  Many times, this is not the smartest or best choice. Your dentist will help you make the best decisions for your care.

6. Why can you only estimate my coverage?
Many carriers do not release accurate details of their plans, or disclose what they will pay for treatments. It is a great frustration for everyone.

7. Should I ask for a written estimate?
The process is designed to be cumbersome so that around 70% of treatment that is estimated in writing never gets done. Many dentists consider pre-estimates a waste of time, as they do not guarantee coverage.

8. How much is dental insurance?
At only about $40-60/ month for family coverage. If your plan is disappointing, consider showing your employer this write-up. They may not be aware of the restrictions and fine-print in the contract they purchased. Better benefits may cost only a bit more.

9. What if my spouse has insurance?
At one time “double insurance” would nearly double your coverage. Today, you will commonly get little additional coverage from a second plan.

10. Do dentists take medical insurance?
Medical plans do not cover dental services, except for a few situations, such as accidents and some oral surgery.

11. How do dentists get on the list of “preferred providers”?
Providers are screened for major legal violations; but for the but for the most part all they have to do is agree to accept lower reimbursements.

12. Can Dentists waive my portion & accept whatever insurance pays?
This may seem reasonable and innocent, but it is actually illegal for your dentist to do so, as it is considered falsified billing. Carriers audit records for such activity and prosecute violators.

13. Can you change codes, or dates, to get me better coverage?
No, this is fraud. Insurance carriers can inspect records, x-rays, lab slips & other records. You and your dentist can be fined or imprisoned.

Dental Insurance Companies

Insurance companies may have numerous plans & coverage can change often. Benefits & carriers vary by state and region. Please contact your Dental Practice directly to see how they work with your specific plan. The following are some of the major Dental Carriers:

American Dental
American Enterprise
Assurant Health
Best Life
Blue Cross/Blue Shields (Various states)
Care Plus
Delta Dental
Delta Dental Premier
Dental Health Alliance
Dental Care Plus
Dental Health Services
Dental Network of America
Dental Select
Dominion National
Guardian Direct
Health Resources
IHC Health
Kaiser Permanente
Kansas City Life
Life & Specialty Ventures
MetLife Dental
Mutual of Omaha
Nevada Dental
Northeast Delta
Pacific Source
Physicians Mutual
Principal Financial Group
Smile Brands
Solstice Benefits
Sun Life Financial
Spirit Dental & Vision
United Service Association
United Concordia
Western Dental
In-House Dental Plan

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