The Murky World of Dental Insurance

The world of dental insurance can be very unclear.  Most of the time, it’s a complete mystery and until someone needs it, it stays unclear.  Although I can’t speak for every dental practice, I can help you with what you’ll need to know to at least get started.

The most important thing to know is that there are MANY different types of insurance plans and they are all VERY different. Often dental and health insurance are separate plans, from separate providers, and you should know whether you are covered specifically for dental insurance.

The best thing to do is to educate yourself on your particular dental plan. Ask your insurance administrator or call your provider directly to find out what type of plan you have and what types of procedures are covered.  Most importantly, you should inquire as to whether you are a member of an In-Network or Out- of- Network plan.

A very simplified way to explain In-Network vs. Out-of-Network is:

• In-Network means you have to go to a participating doctor on your insurance plan’s list.
• Out-of-Network means you can go to any doctor.

The differences beyond that depend on the particular plan, but it’s important to understand that quite often In-Network doctors are sometimes handcuffed by restrictions.  Out-of-Network doctors may have more flexibility with the materials they can use and with the procedures they can do.  If you are at a point where you can choose between In-Network and Out-of-Network plans, speak to your dentist to see what the scope of your dental needs may be in order to pick the type of plan that will work best for your overall dental care.

Beyond educating yourself as to what type of coverage you have, it is important that you be prepared to have the answers to the following questions before you come in for your dental appointment:

• Is this a dental plan that you receive through an employer?
• If it is through an employer, what is the name of the company?
• Does your plan allow you to see any dentist or do you have to see someone that is on their list of doctors (In-Network or Out-of-Network)?
• Who is the subscriber?
• What is the subscriber’s social security number or their subscriber ID (usually found on your insurance card, if you have one)?
• What is the subscriber’s date of birth?

Having all of this information will make the process faster and easier because not all dental insurance plans provide you with an insurance card.  Always remember to bring your insurance card if in fact you do have one.

Whether or not you have dental insurance, it’s also good to know that most Flex Spending Accounts and Flex Spending Account Credit Cards can be used to pay for dental work.  If you decide to forgo dental insurance, it is a good idea to budget any dental needs into your totals at the beginning of the year.  Again, you and your dentist can discuss any procedures he or she may feel are going to be part of your upcoming visits and can help you budget accordingly.

Some offices, including our own, also offer the option of an extended payment plan through an outside financing company.  This allows the cost of the dental work, with a deposit, to be paid off over time, anywhere from 6 – 24 months.  We like to give our patients every possible opportunity to get the care they need even if they don’t have insurance and this allows us to do so.

Although the world of dental insurance can be difficult to navigate, most dental practices have staff that are knowledgeable about dental insurance and can help advise you as to what is the best fit for you.   Most importantly, caring for your oral health through annual check-ups and cleanings is the best way to maintain healthy teeth and gums.  An ounce of prevention can help you avoid more costly dental procedures in the future.