A dentist is discussing with her patient the risk of a procedure recommended by the patient's dental insurance.

Dental Insurance Coverage

As your dental hygienist is cleaning your teeth and taking some X-rays, they discover that you have some kind of dental issue. The doctor assesses the situation and proposes a treatment. Then, the clinic tells you that your dental insurance may not cover the proposed dental treatment. Now it becomes very confusing. Shouldn’t your insurance cover care that is the best for you, the patient?

A dentist is preforming a procedure recommended by the patient's dental insurance.

How invasive is the procedure covered by your dental insurance?

Avoiding Invasive Procedures Covered by Dental Insurance

In dental care, your doctor should propose a solution that is ideal, while also considering how the patient is affected. This includes the invasiveness of the procedure, risks in the process, pain and recovery time, the age and health of the patient, patient’s finances, as well as the long-term benefits the procedure will provide to the patient’s oral health. This type of thinking provides the best treatment and care for the patient.

What if your dentist recommends a treatment that your dental insurance may not cover? You will need to understand what alternative options are available under your dental insurance, and together with your dentist, make a decision.

It is important to have a good understanding of your treatment choices and the outcomes of each. The choice that your dental insurance considers for coverage may be more invasive. More invasive treatments could more than likely lead to complications. The final decision depends on the patient, but the patient should understand what is the best for him or her.

One example of such a situation involves the pulp-capping procedure, which prevents needing root canal treatment.  Insurance companies have guidelines, and sometimes they do not know what a patient needs or what is the best for them. Your insurance company would more likely pay for an invasive root canal procedure—but not for preventing one. They also might approve dental crowns, which requires cutting into the tooth, but not dental onlays that preserves the tooth.

This is probably why most dental providers opt to proceed with a more invasive treatment, which is always a covered under your insurance.  The best option is to be informed, and then discuss the options with your dental provider before you subject yourself to your dental insurance’s choice.


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