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What You Need to Know About Your Dental Insurance

dental insurance
Creative Commons image by Brendan Wood.

With so many different dental insurance plans available, it can be difficult to understand yours. While our office will submit your claim to your insurance company, it’s important to remember that you, our patient, are our first priority. If you need help understanding your dental insurance coverage, it’s best to ask your insurance administrator, though our office staff can often answer some common questions that are not specific to one plan. Here is some of the dental insurance terminology that might help you as you investigate what your plan covers.


Many dental insurance companies assess a yearly deductible, much like your health insurance might. This is the amount that you need to pay the dentist before your insurance will begin covering services. Read the fine print; in some cases, the deductible applies to preventative services (cleanings and routine exams), while in other cases, preventative services are covered before you pay the deductible.


Many, though not all, insurance companies also have a maximum dollar amount that they will pay in any calendar year. If it’s getting toward the end of the year and you have a lot of dental work that needs to be done, you should look into how much of your maximum has been used already to help you budget for your out-of-pocket expense.


Your dental insurance company will have a UCR, or “usual, reasonable and customary,” fee assigned to each procedure code. Unfortunately, in some cases, this fee is not actually what any dental offices in the area would charge; insurance companies use algorithms that might or might not line up with what is being charged in various areas of the country. If you call your insurance company with the procedure codes, they should be able to tell you what the UCR fee is. You can then figure out the difference (if any) between the UCR and your dental office’s fee.

In-Network Providers

Some plans have a list of providers that are in-network. This means that they have agreed to negotiate prices and procedures with the company. In most cases, you can go outside of the network, but you would have to pay a higher percentage of the charged fees. On some plans, you must see dentists who are in network in order to use your benefits.

It’s important to remember that your dentist works for you, not your insurance company. While many times, dental health benefits will cover most basic procedures, if you need extensive work done, it’s likely that you will have an out-of-pocket expense. Talk to your insurance company or your employer if you don’t understand your plan.

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