SHOULD YOUR HEALTH INSURANCE DECIDE YOUR DENTAL TREATMENT?

I’ve had many conversations with patients about their dental treatment needs, and one topic that comes up frequently is dental insurance.

While dental insurance can be a valuable resource, there’s an issue I see far too often:

​Your health insurance deciding what dental treatment they will cover and what they won’t.

Why should your health insurance decide what dental treatments you can have and not a dental expert?

INSURANCE COMPANIES ARE NOT DENTAL EXPERTS

When it comes to deciding what treatments are covered, health insurance companies are making those decisions based on their own business policies, not based on what’s best for your oral health.

Insurance companies are managed by people who may have no background in dentistry, yet they are making decisions about whether or not you can receive certain treatments.
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Your health should be in the hands of healthcare professionals, not the people balancing the books at an insurance company.

INSURANCE LIMITS DO NOT REFLECT YOUR NEEDS

Most insurance plans have coverage limits and restrictions.

They may only cover certain types of treatments up to a specific dollar amount per year.

This can be problematic because your dental needs are unique, and one size does not fit all.

For example, most insurance companies will cover only a single crown each year but you might need 2 due to an injury. They will not cover the second crown even though you might have never claimed one before.

​The problem is, your oral health needs should never be compromised because of a financial cap.

INSURANCE COMPANIES PRIORITISE SHORT TERM SAVINGS OVER LONG TERM HEALTH

Health insurance companies often focus on cost-saving measures that may seem beneficial in the short term but can be harmful in the long run.

They might deny coverage for a treatment that can prevent more serious problems in the future.

For instance, catching and treating a small cavity now is much less costly (and painful) than waiting for it to turn into a root canal or extraction later on.

DELAYS IN DENTAL CARE

When your insurance decides which treatments to cover or how much they will cover, it often means delays in getting the care you need.

This could happen because you have reached the cap of dental treatment that they will cover for the year, and so many patients will wait till insurance benefits reset before proceeding with treatment.

In the meantime, your condition could worsen.

YOUR DENTAL HEALTH SHOULD BE A PRIORITY

While health insurance can be a great help, remember that it doesn’t always prioritize your dental health in the way you or I would.

Dental treatments should be decided between you and your dental professional not by your health insurer.

Check regularly what your dental insurer will cover and ensure that you are taking advantage of it.

IS DENTAL HEALTH INSURANCE WORTH IT?

In 2023 health insurance covered on average 50% of all treatments.

You know you're going to need one or two dental check-ups a year.

Extras cover can help you budget for that, and ideally reduce your out-of-pocket expenses.

In other words, the trick is to pay less in premiums than you get back in benefits.
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If you're just going to use it once or twice a year when you visit the dentist, save your money and just pay for it directly.

THE OTHER OPTION TO HEALTH INSURANCE

Instead of purchasing extra insurance, consider setting aside those funds in a personal healthcare savings account.

By saving the money yourself, you gain the freedom to spend it on the treatments and care that you decide are necessary, without having to rely on an insurer’s coverage restrictions or approvals.

This approach allows you to prioritize your healthcare needs directly, ensuring that your choices, not insurance company policies, dictate your care.

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