Dental Insurance

Dental insurance can be tricky to understand as most insurance policy documents are many pages long. The coverage for each dental service also depends on your individual policy, which can vary greatly if your policy is individual, or one provided by your employer. Luckily, we are here to make sense of insurance policies to ensure you receive the proper treatment and that your insurance provider covers their share. We may do this by submitting the claims on your behalf to find out more about your coverage limits, or providing you with all the paperwork so you can handle the insurance claims with ease.


It would be helpful for you to know your insurance coverage information before coming in as this will help speed along your treatment plans. Some of the questions we usually ask insurance providers include:

  • Does Insurance Cover Implants?

    Some insurance carriers help with the fees required for implant dentistry. It depends on your particular insurance policy. We do not typically recommend making decisions regarding your necessary dental treatment based on what insurance pays.

  • Your Dental Insurance Benefits

    Your dental insurance is based upon a contract made between your employer and an insurance company. We are not a party to that contract. Therefore, should questions arise regarding your dental insurance benefits, it is best for you to contact your employer's human resource department or insurance company directly. It is their responsibility to make sure you know what your plan entails. They will provide you with a benefit summary and plan benefits booklet. It may either be a paper copy, or there will be a detailed website so you can access your plan.

  • Dental Insurance: An Aid, Not Full Coverage

    Dental insurance benefits differ greatly from medical insurance benefits. Most dental insurance plans offer a maximum benefit of $1,000 per calendar year. (This incidentally, is the same average amount of dental benefit provided 20 years ago.) **Therefore, dental insurance is never a pay-all -- it is only an aid.

  • Usual and Customary Dental Fee Notifications

    You may receive notification from your insurance company stating that our dental fees are "higher than usual and customary." An insurance company surveys a geographic area, calculates an average fee, and then takes 50-80% of that fee and considers it customary. Included in this survey are discount dental clinics and managed health care facilities which bring down the average. Any doctor in private practice will have fees that insurance companies define as higher than "usual and customary." Exceeding your plan's customary fee does not mean your dentist has overcharged for the procedure.

  • What to Expect from Dental Insurance Coverage

    Many plans tell their participants that they will be covered "up to 80% or up to 100%" but do not clearly specify plan fee schedule allowances, annual maximums or limitations. It is more realistic to expect dental insurance to cover 35% to 65% of major services. Remember, the amount a plan pays is determined by how much the employer paid for the plan. You get back only what your employer put in, less the profits of the insurance company.

  • Prioritizing Care Over Insurance Coverage

    Many routine dental services are NOT covered by insurance companies. Treatment decisions must be made by you and your dentist. While dental benefit coverage should be taken into account, it should not be the deciding factor in your choice of treatment.

Please call our office with any questions you may have about your plan. We are here to help you maximize your benefits and ensure your claims are processed and submitted in a timely matter.

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