How to utilize your dental insurance to minimize cost

Have you ever wondered why you have to pay so much money even though you have dental insurance? What most people don’t quite understand is that dental insurance is very different from medical insurance, at least yet in 2015.

Unlike the most routine check up appointment at your medical doctor’s office, even a routine dental check up appointment can have many different options to meet each patient’s needs and best prognosis.

For example, most patients make their routine dental appointment to get a “cleaning” which they were informed is covered at 100% when they signed up for the insurance. But when they come in for the first time, they can be told many different treatment options with variable cost based on their dental condition just to get a “cleaning.”

Some need just a simple dental cleaning called “Prophy” in dental world, or some need deep cleaning which is divided by the 4 sections of your mouth called “Scaling and Root planning in each quadrant,” or some may need gum surgery right away to get proper cleaning of their gum which is called “Osseous surgery” with bone graft or without bone graft depending on their condition. When you fall into the latter group of patients, your cost of routine dental treatment can go from $0 copay to hundreds or thousands of dollars of copay. And this is just one example.

Then you may start to wonder, am I getting ripped off by the dentist? Or is my dental insurance that bad? Unfortunately in most cases, it is your dental insurance because most dental insurances cover 100% only when it comes to preventative services which literally means the services to prevent disease. But if you are treating any dental disease that exists in your mouth, your copay can vary 20% to 100% depending on the contract of your dental insurance policy.

And that is why you often feel that having a dental insurance doesn’t help you to get dental treatment that you need. Hence, unfortunately, why a lot of dental treatment is determined by your dental insurance plan rather than what’s best for your dental health. And always it’s better to do what’s best for your health, not what’s best for your dental insurance.

So, having a better understanding of your dental insurance plan helps before you sign up.

Most dental insurance plans are divided by 2 major categories, HMO or PPO. In HMO dental insurance, you have a good coverage for most minor treatments without a yearly maximum limit, but you have little benefit for major dental treatment. You also have a very limited access to dentists since there are not a lot of participating doctors. And you can only have one primary dentist with this plan and you can not see any other specialist without his/her referral to a specialist that participates; again, only few specialist dentists participate in HMOs. 

In PPO dental insurance, you still have good coverage for minor treatment, similar to HMO, on top of better coverage for some major treatment. So if you need some major dental treatment, your copay may be lower than having HMO, however, of course there’s a trick. In PPO plans, there normally is a set yearly maximum limit, so once you go over your yearly maximum, everything is out of your pocket cost. Lastly, there tend to be more participating doctors for PPO plans than HMO, and you can generally see any dentist using PPO plan whether they participate or not.

I created a very simplified table of comparison of the two major categories to help you understand better. But there are a lot of subcategories of dental plans and your policy can change every year. Therefore, you have to literally understand all the fine lines of your particular plan each year, whether the treatment that you need is covered to minimize your cost. So understanding your own plan thoroughly before you sign up will certainly help you to get better treatment with less cost. But the most important thing to understand, is to take care of your dental health with the best treatment option regardless of your insurance plan; ultimately saving you cost in the future.

by :Dr Ivy Hwang

Dr. Hwang obtained her dental degree at Columbia University in New York City and completed her residency at Newark Beth lsrael Hospital in Newark, NJ. She excels in Cosmetic, lmplant and General dentistry making her sought after for the complex and routine dental treatment. She is currently a Fellow in The International Congress of Oral Implantology. She strives to treat and care for her patients to make each dental visit as pleasant as possible.
Dr. Hwang continues to attend various continuing education programs to provide the best and most up to date treatment options to her patients. Aside from dentistry, she enjoys spending time with her husband, family, and friends, traveling, running, and watching sports.