How Insurance Plans Work

Many of our patients use dental benefit plans, so we would like to explain why your insurance may not cover the entire cost of your dental procedure, or why it covers some dental procedures and not others.

Most dental benefit plans are the result of a contract between your employer 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 plans may want you to choose your dental care from a list of their preferred providers. 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 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 plans do not provide coverage for all dental procedures. 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 services.

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

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