We often hear from patients who are understandably frustrated when their insurance doesn’t pay for a procedure they believed was covered. If you’ve experienced this, you’re not alone—and it’s not your fault. Dental insurance is complicated, and we want to help clarify what “coverage” really means.
Insurance plans list procedures as “covered benefits,” but that doesn’t mean they’ll automatically pay for them in your case. Many factors determine whether a procedure is reimbursed, including plan limitations, timing, material allowances, and diagnosis codes.
Even if your dentist recommends a procedure for your health, your plan may not consider it necessary based on their definitions. Coverage depends on whether the procedure fits your policy’s specific guidelines, not just your clinical needs.
We can request a pre-treatment estimate to get a general idea of what your insurance might cover. However, this is not a guarantee. Final decisions are made only after the claim is submitted and processed.
Our team verifies your insurance and provides the best estimate possible before treatment, based on the information your insurance company provides. Still, all coverage decisions are ultimately up to your insurer.
Even with insurance, most patients will have some level of out-of-pocket responsibility. This could be due to deductibles, annual maximums, downgraded benefits, or portions of the fee that exceed the insurance company’s allowable amount. We’ll always do our best to inform you ahead of time so you can plan accordingly.
We know how confusing and frustrating dental insurance can be. Our goal is to help you make informed decisions about your care while navigating these complexities as smoothly as possible. If you ever have questions, we’re here to walk you through it.
