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Dental Insurance Demystified

Myth #1 - My dental insurance tells what I need for treatment.


No, your benefit plan may be determined by you or your employer. It is meant to offset the regular cost (think of it as a coupon). When they make plans, they don’t consider individual needs a person may have. It’s best to discuss your needs with your dental provider. The best practice is to know insurance does not dictate treatment.



Myth #2 – I have 100% coverage, so that means I should have no portion left to pay.


Each plan has its own fees associated with procedures. Some plans do not cover the exact price of the fee that the office is charging. It would be best if you asked your insurance provider what their fees are and compare them to your preferred office.


Myth #3 – If I don’t have dental insurance then I can’t afford to go.


Although the idea of an unknown price is scary, talk to your dental professional about costs and discuss options for how you can afford it. Services are individualized, and if you are on a budget, make it clear on what’s most vital for you to have done and work together.


Myth #4 – My dental insurance only covers a cleaning every 9 or 12 months.


Scaling or debridement is offered in “units of time” (15 minutes). You may get 4 or 8 units per year; this means you can shuffle that time around as needed. If you have more complex periodontal disease maintenance needs, then you may need to come more often. Your insurance may not cover the extra time; you must follow your dental professional's advice to prevent bone loss and gingivitis.


Myth #5 – My dental officed knows what my plan covers.


Each benefit plan is so different that it is challenging to know each plan completely. Since you are the policyholder, you should understand your dental plan, so you can tell the dental office what is covered. You can call or email.


Some questions that may help you to learn about your coverages are:

  • What’s my plan maximum? Is there a difference in coverage for basic and major?

  • How many units of cleaning time do I get? Polish? Fluoride?

  • What’s the frequency of my x-rays and assessments? Is it a calendar year?

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