Myth #1: My Dental insurance will cover everything – “I have 100% coverage.”
Dental insurance is not really insurance at all – it is a benefit plan that helps to pay some of the costs of dental care. Your dental plan has a set of fees that they will pay up to. Your dentist generally has the same fees as other dentists. The fee reflects the quality of the treatment that you receive as well as the cost to provide it. Often there is a difference between what the insurance plan will pay and the fee for treatment. The difference, known as the ‘co-pay’ amount, is up to you. Your dentist cannot legally just “write it off”. Unfortunately dental plans have the same $1000-$1500 benefit as plans did in 1970. If you factor in inflation alone, they should pay a minimum of $3000 per year. The cost of providing dental treatment has increased well beyond inflation through this time period, further increasing the gap between your benefit plan maximum and the true cost of treatment. Your benefit plan is negotiated by your employer, and is a contract between you and the insurance company. Unfortunately the cost to provide these plans keeps going up and your employer needs to keep costs down, so the trade-off to keep premiums low is to simply not increase the maximum benefit.
Myth #2: If my insurance doesn’t cover it, I don’t need it.
Dental insurance pays for a healthy adult with minimal to no dental problems. If you have any form of gingivitis (gum infection), periodontal disease, or need more extensive treatment like dental implants, you may find that your plan will help with the first $1000-1500, and the rest is up to you. Only an oral healthcare professional can diagnose what is needed for each individual. Dental insurance will only cover what was negotiated in the policy with your employer. The insurance company will decide whether something is covered or not based on the plan you have, not based on whether it is the appropriate treatment or whether it is necessary. Dental insurance is there to help defray the costs of dentistry, but ultimately does not override what was diagnosed by the doctor.
Myth #3:Dental insurance only covers a cleaning every 6/9 months.
This is not true - coverage for 6/9 months is only limited for the doctor exam portion of the visit (when the dentist checks your teeth). This has nothing to do with the actual dental scaling and polishing that the dental hygienist provides. Unfortunately, many patients are misinformed and this can have a detrimental effect on oral health. Dental cleaning helps remove bacteria and toxins that collect on the teeth, both above and below the gum line, which can cause oral disease. For patients who have active oral disease, such as gingivitis or periodontal disease, the frequency in which the teeth must be cleaned can mean the difference between halting a disease process or further destruction of the gums and jaw bone. The majority of dental plans will support regular care visits with your dental hygienist at the interval recommended for you based on your oral health, and the doctor will complete a checkup for you either when your plan will pay for it, or when the dental team determines it is necessary with your consent.