Dental Tips Blog


Why Doesn’t My Insurance Cover That?

Posted in Dental Costs

Have you ever gone to the dentist and been told that you needed to have a certain procedure in order to restore, repair, or save a damaged tooth? Perhaps it’s been years since you’ve had a dental check-up due to lack of insurance coverage, and now that you’re on a new plan you just want to get your smile healthy again. After talking about what options you have to restore your teeth, the financial coordinator discusses the fees for each service and your estimated insurance benefits, only to find out that your insurance may or may not pay for a certain procedure.

Your insurance coverage is based on the type of plan that either you or your employer have chosen as part of a package. Some types of insurances only cover a set percentage of certain procedures, regardless of the price. For instance, a common example is an insurance plan that pays 80% of restorative procedures and 50% of major procedures. This leaves the patient responsible for a portion of their fees, and requires a financial investment on behalf of the patient for care to be completed. Other types of insurance plans are based on a percentage of the fee, assuming that the fee does not exceed a dollar amount. If the fee goes over that amount, the additional difference is the responsibility of the patient.

Getting routine preventive care is important to keep your smile healthy and maximize the amount of coverage that most patients receive. Typical insurance plans cover 100% of preventive procedures, maximizing the patients ability to access routine dental cleanings and checkups, exams, and x-rays to screen for decay before it becomes too progressed.

Posted on behalf of Dr. Michael Mansouri, Lawrenceville Family Dental Care, P.C.


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