Dental insurance is fairly new, unlike medical insurance. By the 1970s and beyond, these plans became more widely available, with a maximum coverage of around $1,000. Even now, there is still much information to learn about how dental insurance companies work with dental treatment centers.
Learn more about common dental insurance questions and how Family Dentistry of New Jersey can help with financial dental costs. Reach out to us today to get more information on our payment plan.
Who Decides What Is Covered Under Dental Insurance?
In the early days of dental insurance, in-network and out-of-network providers were not separated. Instead, rates were established for the area, and plans would pay for most — if not all — of preventative care, 80% of minor dental work and 50% of major work.
Now, dental insurance companies are owned by stockholders, investment bankers and equity firms. Medical insurance companies can have unlimited liabilities with significant claims, but dental insurance plans have a cap on coverage. This system creates a very lucrative business. If a dental insurance company wants to make more money, the owners can limit your care without considering the consequences to those under the plan.
Ultimately, it isn't up to you or your dentist to decide what is covered by dental insurance — it all falls in the hands of your dental insurance company. More and more often, due to the restrictive nature of dental insurance plans, those enrolled in them find it difficult to find a dentist who is in-network in their area or does not allow out-of-network coverage, which greatly limits access to the quality care that they need.
What Does Dental Insurance Not Usually Cover?
Dental insurance can be tricky on what it covers under your current plan. Our dentists work for you and not your insurance company! While we try to design treatment plans for you that fit within your insurance coverage, it is our duty to present you with optimal care options, even if they fall outside your dental insurance benefit. You must decide if you wish to do what is best for your health or allow the insurance company to determine what is best for you and your family.
The following list contains some dental procedures that are frequently necessary but not covered under dental insurance:
- Correcting preexisting conditions: Dental insurance companies will claim to cover major reconstructive dental work, such as crowns and bridges. However, be aware of “preexisting conditions.” This stipulation means the dental company would not pay claims for a replacement if a tooth was missing before coverage. Check your policy for the “missing tooth” clause.
- Cosmetic care: Deciding to boost your confidence with a straighter, brighter, healthier smile is typically not covered under dental insurance. Dental veneers, whitening or gum recontouring are all omitted from coverage benefits.
- Dental implants: Many insurance companies consider dental implants purely cosmetic and not a necessary procedure and will not cover them.
- Replacement of metal fillings: Many people wish to change their old amalgam fillings to white composite fillings, which is not allowable. However, suppose your amalgam filling is failing and requires replacement, and you wish to replace it with a white filling. In that case, your dental plan will limit or downgrade your benefit to only the coverage of an amalgam filling.
- Additional cleanings: Some people require a 3-month recall rather than a 6-month one. Most dental insurance companies do not cover the two additional cleaning visits.
- Therapeutics: Many therapeutic services, such as Arestin for treating periodontal disease, Botox or treatment for TMJ disorders, are typically not covered.
- Frequency of care: If you had a crown placed four years ago and it breaks and requires another crown, it is often not covered because dental insurance will only cover one procedure per tooth every five years!
How Family Dentistry of New Jersey Can Help With Financial Stress Regarding Dental Coverage
At FDNJ, we believe everyone should be able to get high-quality treatments and cosmetic care without breaking the bank. We offer a Healthy Smiles Value Plan that includes all the following benefits:
- Two complete exams and one emergency exam
- All necessary X-rays
- Two cleanings per year with fluoride varnish application
- No yearly maximum benefit
- No deductibles
- No pre-authorization requirements
- No denial due to preexisting conditions
- No denied coverage
- No waiting periods
- Free consultations
Connect With the FDNJ Team Today
With the Healthy Smiles Value Plan, you and your family can access the dental care you need outside of an insurance company's control. You stay in complete control — contact us by calling 732-458-2288 today.