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For You, About You Dentistry

A simple guide to understanding your dental insurance and getting the most out of your dental benefits.

Having dental insurance is like owning a Roomba.


You can bring your new Roomba home from the store and take it out of the box. You can take the plastic off and place it on the floor.


But if you don’t turn it on and set it up, it’s just going to sit there doing nothing.


Even if you bought the super-deluxe unlimited power model, if you don’t know how to make it work, then your floors won’t get any cleaner, and the money you spent will have gone to waste.


The same goes for your dental insurance coverage.


If you don’t take the time to learn what your benefits are and how your policy works, the only thing it will do is sit there collecting dust. Like a poor, useless Roomba.


The worst part about this situation is that you could be leaving a ton of savings on the table.


Depending on what type of dental insurance coverage you have, you could be saving money on regular dental checkups, cleanings, and various treatment plans!


Our mission at Dental Express is to provide top-notch dental care while saving you as much money as possible. When it comes to your dental insurance coverage, transparency is our highest value.


To make sure you understand the full extent of your dental benefits, we’re going to cover the four downfalls of dental insurance and some useful tips you might not know on how to make your policy work for you.


The Four Downfalls of Dental Insurance

The two key takeaways from this article, if you learn nothing else today, should be to:

  1. Know your benefits, and
  2. Understand your policy


Understanding what your dental insurance coverage can do for you is the first step to reaping all of your dental benefits.


What’s your yearly maximum? Do you know your deductible? Does your insurance cover the full cost of preventive care visits or only a portion?


If you don’t know how to answer these questions, set aside some time to learn about your dental policy. Call your insurance provider to go over it with you if you need to.


Your smile is worth it, and it could save you a lot of money.


To help with this process and put you on the fast-track to savings, we’re going to go over the four downfalls of dental insurance.


These pitfalls are the main features to be aware of when understanding your dental insurance plan and how to take full advantage of it.


Downfall #1: Waiting Periods

Waiting periods are downfall number one because if you’re not careful, they can take you by surprise at the start of your dental coverage.


A waiting period is set by your insurance provider and is the amount of time you have to wait before your dental insurance coverage takes effect.


Waiting periods are put in place to keep you from scamming the system by signing up for coverage, getting a ton of dental work done, and then canceling your policy.


But you would never do something like that…right?


All jokes aside, not all dental policies have waiting periods, and not all waiting periods are the same. Some waiting periods last longer than others, and some allow coverage for certain dental treatments while others don’t.


Your plan might have you pay your premium for six months or even a year before your full coverage starts. Or, it might cover routine checkups but only provide partial or no coverage for major treatments.


This variety in standards is why you need to read up on your dental insurance policy to see if it requires a waiting period, and if so, what the details are.


People often get excited about starting or switching to a new policy during open enrollment, and without fully understanding their coverage, they head straight for the dentist.


Little do they know, there’s a waiting period that keeps them from getting the affordable dental care they were looking for.


Someone forgot to program their Roomba. Yikes.


But don’t worry. At Dental Express, our treatment planners will go over your dental coverage with you before any procedures, so you know where you stand.


Have complicated insurance questions? We’ve got simple answers.


We’re always happy to clear up any confusion about your dental insurance coverage. Please don’t hesitate to give us a call or ask any questions you may have when you come into one of our offices in San Diego .


In addition to waiting periods, pre-existing conditions can also heavily impact your dental coverage.


Many plans will cover smaller pre-existing issues like cavities, but if you need more expensive care like partial dentures or a dental implant, your insurance may not help with the costs.


These issues lead us to our second downfall: the missing tooth clause.


Downfall #2: Missing Tooth Clauses

Many dental insurance plans have what’s called a “Missing Tooth Clause,” which is how insurances avoid paying for dental care that addresses pre-existing conditions.


Say you get a tooth removed before signing up for a new dental insurance policy. 


Because you got the procedure done before your coverage began, the missing tooth clause in your plan absolves your insurance of having to pay for the bridge or implant you want to replace your tooth with.


Now, you’re stuck without an affordable solution to your issue. Either that or you’re stuck with the full cost of an expensive dental procedure you weren’t prepared for.


Not exactly a fun situation to be in.


Always make sure to look for a Missing Tooth Clause in your dental policy. Read all the fine print. 


And if you’re confused by the fancy language they use, give us a call at Dental Express. We’re fluent in dental insurance.


If you have a serious dental issue that needs attention and you’ve just signed up for a new dental insurance policy, discuss your options with your San Diego dentist before moving forward with any procedures. 


Depending on your issue, you may be able to get by with preventive care while you wait for your benefits to kick in, which will save you money in the long run.


Downfall #3: Alternate Benefit Applies

Alternate Benefit Applies is insurance lingo for, “We’re not going to pay for that because there’s a cheaper option. Sorry, not sorry.”


If they respond with this line when you go in for treatment, your dental insurance plan is the type that covers only the minimal available treatment. 


You might hear this when you go to get composite tooth colored fillings front teeth, and they say they’re only willing to cover a metal amalgam. Or, you want to get a dental implant, but they’ll only agree to cover a partial denture. 


“Alternate benefit applies.”


When you’re shopping for affordable dental insurance plans, pay attention to how they cover these four types of care:

  • Preventive Care: preventive care includes pretty much everything you get done at a regular checkup—dental cleanings, routine x-rays, fluoride treatments, etc. Most policies cover the full cost of these visits, while others only take care of a little over half. If you can, choose a policy that pays your preventive care tab in full. These appointments mean the most for your dental health because they help you avoid more serious and expensive issues.
  • Basic Restorative Care: fillings, non-routine x-rays, anesthetics, and extractions are all examples of basic restorative dental care. Many plans cover around 80% of these procedures after you’ve met your deductible. Study your policy to see what percentage of basic care it covers. And if you want to avoid the “Alternate benefit applies” line, keep in mind that you’ll likely have to pay higher premiums.
  • Major Restorative Care: major restorative procedures are your crowns, bridges, root canals, dentures, and other serious dental treatments. Typically, dental insurance plans cover half the cost of these visits after you meet your deductible. Again, check your plan to see where you stand with major restorative care.
  • Orthodontic Services: affordable dental insurance plans usually don’t cover orthodontic care. If you have the extra cash, there are plans out there that help with things like braces. Otherwise, talk financing options with your local orthodontist or give us a call at Dental Express for more information.


Understanding how policies handle these types of care means you’ll be able to find the one that works best for you. It’ll also give you a clear idea of how dentist visits will affect your wallet.


Downfall #4: Use it or Lose it!

Last, but quite possibly the most important downfall of dental insurance is: 


If you don’t capitalize on your dental benefits by the end of the year, you’ll lose them!


Yes, unfortunately, dental benefits don’t work like rollover minutes. Once the new year hits, whatever benefits you leave on the table from the previous year are gone for good.


So, if the end of the year is approaching and you notice that you haven’t hit your yearly maximum, take a trip to the dentist. Bring your family along if you can. You might catch something that your dental insurance plan can cover before your benefits expire. 


At the very least, go in for a routine checkup and cleaning. What’ve you got to lose? The more you go to the dentist, the healthier your smile will be.


Besides, you’re paying your premiums for a reason. Make the most of your benefits while you can!


Speaking of taking advantage of your benefits, want to know a useful dental insurance hack?


The end of the year is the perfect time to plan any expensive dental treatments you might need. 


If you wait until the end of the year, you can cover a chunk of the cost using what’s left of your benefits from the current year. Then, when your benefits reset in January, you can apply as many as you need from next year’s maximum to take care of the remaining costs.


Share this tip with your friends and family. They’ll thank you later!


HMO vs. PPO Dental Insurance

The difference between HMO and PPO dental insurance plans is straightforward. 


Health Maintenance Organization or HMO dental insurance plans usually have cheaper premiums, but there’s a catch. With HMO plans, your provider is chosen for you. You may also have to go through your primary care physician to receive care.


Preferred Provider Organization or PPO dental insurance plans provide you with a network of providers you can choose from. Dental Express is an example of an in-network PPO provider in the San Diego area. While these plans are typically more costly, they give you the freedom to shop in-network for a dentist you prefer. 


So, if you and your family didn’t enjoy your experience at a particular dentist’s office, you don’t have to stick with them. You can look around for one that you like and can entrust your smile to. 


Need some tips on how to find the right dentist for you and your family? Click here for a helpful article explaining what to look for in a general dentist.


Whichever plan you choose, do your best to stay in-network. Something as simple as a routine checkup and cleaning can cost around $200 if you go out of network. And that’s just basic preventive care. Imagine if you needed a dental root canal therapy or a bridge put in. 


Major dental procedures are nerve-wracking enough. There’s no need to put any extra stress on yourself or your wallet. Stay in-network.


Key Points to Know About Your Dental Insurance Coverage

To sum up, here are the essential items to keep in mind when it comes to your dental insurance plan: 


  1. Know your annual maximum.
  2. Know your deductibles.
  3. Does your plan have a waiting period?
  4. Does your plan have a missing tooth clause?
  5. Stay in-network.
  6. Use it or lose it!


Once you get these down, you’ll have a better understanding of how to make your policy work in your favor, helping you keep your smile healthy and happy. Not to mention, budgeting for visits to your local San Diego dentist will be a breeze!


Working Together for a Brighter Smile

Dental insurance can be so complicated that it seems purposely confusing at times. That’s why we’ve made integrity and transparency our driving principles at Dental Express.


When our dentists recommend a treatment to improve your dental health, one of our treatment planners will meet with you to discuss your coverage.


These meetings are where your newfound knowledge of your insurance plan comes in handy! 


Our treatment planner will ask you questions about your dental coverage. Based on your answers, they’ll decide which treatments or procedures your insurance is most likely to cover.


While we can’t fully guarantee what your insurance will or won’t cover, our treatment planners will work with you and your insurance to build the best possible estimate based on your benefits.


Then, once the claim is verified, we’ll schedule your treatments and you’ll be on your way to better dental health.


At Dental Express, saving you money is second only to giving you a brighter, healthier smile on our list of priorities.


If you ever have any questions in or outside the office about your dental insurance coverage or where to find affordable dental insurance plans, please don’t hesitate to ask us. 


And if you’re looking for affordable dental care in the San Diego area, make an appointment at one of our locations today. 


We’re right around the corner, and we’re always here to help.