How Insurance Plans Work

How Insurance Plans Work

Many of our patients use dental benefit plans, so we would like to explain why your insurance may not cover the entire cost of your dental procedure, or why it covers some dental procedures and not others.

Most dental benefit plans are the result of a contract between an insurance company and your employer, union or association. The person who negotiates the terms of your insurance plan makes the final decision on maximum levels of reimbursement through a contract with the insurance company.

Other plans may want you to choose your dental care from a list of their preferred providers. Choosing your dental care provider from this defined group can affect your levels of reimbursement. Your plan may also tell you that they will only pay benefits for the least expensive alternative treatment for a condition, or deny coverage for conditions that existed before you enrolled in the plan.

A deductible is the amount of dental expense for you are responsible for before your plan will assume any liability for payment of benefits and could increase your out-of-pocket expenses. In addition, many plans do not provide coverage for all dental procedures. This does not mean that these procedures are not necessary – it just means that your employer has purchased a plan that does not cover the cost of providing coverage for these services.

If you have questions about your dental benefits plan, we recommend you contact your insurance provider or your human resources department at work.

The Benefits of Direct Reimbursement

In recent years, corporate belt tightening and insurance companies may have limited your choices when it comes to dental care. When your employer implements direct reimbursement, you visit the dentist of your choice, receive treatment, and arrange for payment. After your appointment, you present a paid receipt or proof of treatment to your employer or plan administrator for reimbursement. In addition, many plans will allow benefits to be assigned directly to the dental office. 

This plan reimburses you based on total expenses incurred. There are typically no deductibles and few excluded services. It frees us to determine exactly the care you need for a healthy and long-lasting smile. Direct reimbursement also helps you avoid unpleasant financial surprises since you can calculate your share of the dental expense in advance.


Talk with your employer or benefits administrator about the value of direct reimbursement.