Why Does My Dental Insurance Cover So Little???

-By Dr. Warren E. Woodruff

When most people think about health insurance, they first think about covering costs of treatment for serious medical conditions or accidents. That’s a natural thing to do. But there’s another type of insurance that’s equally important to your well-being.  That is dental insurance.  Because dental disease is so common, being protected by dental insurance and using it wisely are essential safeguards for you and your family.

Unlike medical disease, which can be both unpredictable and catastrophic, most dental ailments are preventable.  Preventive care, including regular checkups and cleanings, is the key to maintaining your oral health. With regular visits to the dentist, problems can be diagnosed early and treated without extensive testing or elaborate and expensive procedures. That keeps the costs of dental care much lower than those of medical care.

Medical insurance is designed primarily to cover the costs of diagnosing, treating and curing serious illnesses.  This process may involve a primary care physician and multiple specialists, a variety of tests performed by doctors and laboratories, multiple procedures and masses of medications.  Depending on the health, age and attitudes of people in the medical coverage group, costs can fluctuate widely.

Dental insurance works differently.  Most dental coverage is designed to ensure that the patient receives regular preventive care. High quality dental care rarely requires the complex, multiple resources often required by medical care.  A thorough examination by the dentist and a set of x-rays are all it usually takes to diagnose a problem. Because most dental disease is preventable, dental benefits plans are structured to encourage patients to get the regular, routine care so vital to preventing and diagnosing the onset of serious disease.

The majority of dental benefit plans are only designed to cover a portion of the total cost of a person’s necessary dental needs.  For example, a dentist may recommend a crown for a tooth that has extensive decay, however, the dental plan may only cover the cost of a filling.  This does not mean that the patient does not need a crown, only that the benefit is limited to a filling.

This previous paragraph is very important because I have encountered many patients whom, due to not maintaining routine dental care, are now faced with extensive dental needs but are only willing to agree to treatment that their dental insurance covers.  The problem is that the maximum annual dental insurance allowance is usually around $1,500.  This number hasn’t changed since the mid 1970s but dental fees have increased over the last 40 years due to higher overhead costs.

So that leaves the patient and the dentist in a dilemma.  The dentist, on one hand, wants to treat the dental disease that the patient has so it doesn’t worsen or cause more serious problems to the patient’s overall health.  The patient, on the other hand, who may have multiple teeth that need to be treated, is now asking the dentist to only treat certain teeth while neglecting the others until they get their next round of dental benefits ($1,500 at the beginning of the next year).

The patient’s decision not to take care of all their dental problems usually leads to more extensive AND expensive procedures in the future.  The patient also may be putting their health in jeopardy while delaying dental treatment.  The analogy I like to use is if a person went to their physician and was told that they have heart disease that could be treated now if the patient was willing to cover some of the costs or the patient could put their life in jeopardy by waiting for more insurance benefits to come during the following year.  I think most people would choose to have the treatment done now even if it meant paying a portion out of pocket since it could potentially save their life.

For a more detailed explanation about dental insurance and answers to Frequently Asked Questions I recommend going here (courtesy of the Michigan and California Dental Association): FAQs About Dental Insurance



There were a couple of additional FAQs that weren’t included in the above link that I wanted to include as well:


Why does my dental insurance only pay twice a year for cleanings but I have been recommended for more frequent cleanings?

While a twice yearly insurance payment toward the cost of teeth cleaning is common, that type of payment arrangement actually has no relationship to what any patient might really need. It’s just how their dental benefits plan was setup.

Many patients need cleanings more frequently.  People who have heavy plaque, lots of calculus buildup, or gum disease are prime candidates.  Also, people who are generally healthy but have certain types of systemic conditions, such as diabetes, or those taking specific medications, may require more frequent cleanings.

In fact, most dental benefits plans require patients to assume a greater portion of the costs for treatment of dental disease than for preventive procedures. By placing an emphasis on prevention, and by covering regular teeth cleaning and check-ups, Americans saved nearly $100 billion in dental care costs during the 1980s.


My dental insurance has a deductible. How does that work?

Ok, let’s say your insurance has a $100 deductible. Deductibles apply once every year, be it calendar year or business year. Some businesses have a business year that begins in, say, June, and ends May 31st of the following year. For this example we will assume your insurance goes by calendar year, January to December.

Assume you go to the doctor in January for a covered procedure, and the charge is $100, and your insurance pays 100% R/C on a 80/20 split. If your deductible was met, the insurance would have paid $80.

However, since your deductible has not been met, $80 of your doctor’s visit will go toward your deductible and not be paid to anyone. Most patients do not realize that the amounts that go toward the deductible are only what insurance would have paid, not the whole charge.


Maintaining a healthy mouth is important for a variety of reasons.  Many signs of diseases can first be detected in your mouth such as diabetes, anemia, oral cancer, cardiovascular disease to name a few.  Our goal at Orchard Maple Family Dental is to prevent dental disease before it starts.  This way it will keep your dental fees to a minimum while keeping you healthy at the same time.

We accept a variety of dental insurances.  We also have many affordable alternative options for those who may currently not have any dental insurance.  Please visit our insurance page for more information: https://www.omfdental.com/make-appointment/insurance.html

Give us a call today at 248-851-2876 and we will be happy to answer any additional questions you have as well as set up an initial appointment for you.  We look forward to seeing you soon!



California Dental Association: www.cda.org

Michigan Dental Association: www.smilemichigan.com

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