Do You Take My Dental Insurance?


One of the most frequent questions we hear from our dental patients is, “Will my dental insurance pay for this?” The answer is, “It depends.” Why? The reality is that every insurance provider offers different benefits, and the details can be confusing.

Many of our patients are insured under various insurance plans and are unsure how or if their insurance can be used here. Even though you may be able to use your dental insurance, it is essential to realize that not all procedures are covered, and many are only covered partially.

Dental insurance pays for some oral care, but not all. Before you depend on your dental insurance to take care of all your dental needs, you will want to learn about your benefits and identify what procedures are covered and to what extent.

Types of Dental Insurance Plans

There are a variety of dental insurance plans available to patients, and each plan works differently. The dental insurance company may also have a few different options to choose from, with coverage for care dependent on which plan you choose. Some plans will allow you to choose your dentist, while others will give you a list of providers within their network. Your out-of-pocket costs also depend on the plan you choose.

  • Dental health maintenance organizations, or DHMOs, have limited networks, and coverage is restricted to only those providers within the network. Dental care outside the network may not be covered at all, or if it is, it will be minimal.
  • Dental preferred provider organizations, or DPPOs, will provide a list of dental professionals within the network; however, they will also cover some services you may receive from dentists who are not in the network.
  • If you have a dental indemnity plan, you can choose your dentist without restrictions, and you do not need a referral to see a specialist.

Dental insurance plans are often one of the benefits provided by employers. If you are allowed to choose a dental plan, be sure to read it over, ask questions, and select a plan that fits your needs. Do your research and talk with your dentist to identify the plan that best fits your circumstances. While many dental insurance plans are network-based, some are not. Also, you should note that some dentists do not participate in in-network contracts.

Your Out-Of-Pocket Costs

The percentage of the total cost patients pay for their dental care depends on the plan they have. Co-payments, deductibles, and co-insurance are your responsibility. The purpose of this cost-sharing system is to help control costs. Dental insurance will usually wholly or mostly cover diagnostic and preventive care, such as cleanings and oral examinations. Other procedures are limited to partial coverage by insurance and generally may need to be approved by the insurance company before work can begin.

Know Your Limits

Dental insurance comes with annual and lifetime maximums on how much can be spent for dental care. You should know what these limits are, so you can plan accordingly and take advantage of the benefits you have each year.

  • Your insurance may cap the number of services you can receive in a given amount of time. For example, a limit on how many dental exams or cleanings you can have in a year is common.
  • There is also a limit on how often some dental work can be replaced. You may have to wait a number of years before replacing dentures or a crown.
  • Elective procedures, such as teeth whitening and other cosmetic procedures, are not always covered. Even when your dentist suggests a procedure, such as a dental implant, you may need to pay for it yourself because dental plans seldom cover such procedures.

Our office is a fee-for-service office, and while we are not a network contract practice, we do work closely with all PPO dental benefits companies. Schedule your appointment with us today, and we will be happy to help you file your dental benefit claim.

Remember, healthy teeth make a healthy smile!

Dr. Nishan Halim

Nishan Halim, DMD specializes in a comprehensive approach to dental care in his Capitol Hill, Washington DC neighborhood dental center. When treatment plans include specialty work, he coordinates every step with the practitioners you choose from his referral network. Contact Dr. Halim to schedule an appointment.

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