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What Does it Mean When Dental Insurance Won’t Pay?

Dental Benefits ClaimWhat does it mean when your dentist has recommended a treatment or procedure that your dental insurance plan won’t pay for? Does it mean that the procedure isn’t really necessary? Does it mean that you should start looking for another dentist in Scottsbluff? Finding yourself caught between your insurance company and your dentist can be awkward and confusing, but with good communication, the issue can generally be resolved in a way that is best for you.

Insurance companies often rely on very complicated formulas for determining which procedures are covered and which ones aren’t—and how much is covered in one day or one year. Some plans include exclusions and limitations for reasons that have nothing to do with your oral health, but more to do with other outside factors. For example:

  • Some plans won’t pay for replacement teeth like implants and bridges if you had a missing tooth prior to your enrollment in the dental plan—even if you had a tooth pulled years ago and would now like to strengthen your bite by replacing it.
  • Some plans will only pay for one tooth replacement in a lifetime. That means that you may not have coverage for the implant that the dentist recommends if your plan has ever paid for a bridge or a partial denture.
  • Some plans will only cover x-rays every other year—even if your dentist recommends them annually.
  • Some plans will cover the cost of silver fillings—even if a bonded tooth colored filling has been recommended.
  • Some plans won’t cover the cost of fluoride treatments and sealants for patients over the age of 12—even if these treatments could prevent cavities in an older patient.

Ultimately, choose a Scottsbluff dentist will always begin by recommending the treatment that is best for your health, rather than allowing an insurance contract to dictate your choices. If you are aware of any limitations or exclusions defined in your plan, talk to the dentist today for help in exploring your options.