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Does Dental Insurance Help Treat Existing Dental Problems?

Does Dental Insurance Help Treat Existing Dental Problems?

One of the biggest reasons why people look into a getting dental insurance policy if they don’t already have one, is because they or their child have developed dental problems that finally need to be treated. But what happens if you sign up for a new policy, only to find out that it doesn’t cover the services that you’re really relying on? Having tooth pain with insurance that doesn’t pay for treatment is like adding an insult to an injury. What can be done to make sure this doesn’t happen and leave you in a bind?

Here’s what you need to know about how (and if) your dental insurance will cover that next trip to the dentist.

When Waiting Periods Come into Play

Perhaps your dental insurance does cover an existing dental problem, but you have to let a certain period of time pass by before you can apply your benefits toward the treatment. This window of time is known as a waiting period.

Waiting periods were developed by insurance companies to prevent people from enrolling in the plan, using all of the funds, and dropping coverage before the insurance company could make their money back. You’re essentially having to “pay into your plan” for the first few months, so that the insurance company has funds to work with.

While this might not be a problem if you don’t usually have dental concerns, it can create significant issues if you’re desperate to have major dental work done (like getting a crown or root canal.) But if you’re just planning for the future and aren’t sure what kind of treatment you’re going to need later on down the road, then the waiting period might not be much of an issue for you at all.

What About Pre-Existing Conditions?

An existing dental problem can cause confusion when your dental insurance policy has what’s called a “pre-existing clause.”  What that means is that if you already have an existing condition that needs to be treated before you enroll in the insurance plan, you might not be able to use your benefits to cover the cost of the treatment. Those treatments — even if they would normally be covered — are excluded.

Here’s an example: You had a toothache and it was causing you severe pain. It turned out that the fastest way to get pain relief was to have the tooth pulled or get a root canal. Since you didn’t have insurance, you decided on the extraction, hoping to replace the tooth later on. A couple of months later, you sign up for a new insurance plan in the hopes of getting a dental bridge or implant…but you find out that there’s a pre-existing clause that excludes a tooth replacement for a tooth that was extracted prior to the plan taking effect. So you either go without the treatment at all, or pay for it out of pocket all over again.

Fortunately, some plans only require that you allow a certain amount of time to pass by (waiting period) before the temporarily excluded treatments are covered under your insurance policy.

How do You Know What is — or isn’t — Covered

During your dental exam, your dentist will discuss the types of treatments available to meet your specific concerns, and calculate a treatment plan based on those recommendations. If you have dental insurance, the office will verify your benefits prior to calculating the treatment plan. Once you have all of the numbers in front of you, it’s possible to see what’s covered or what isn’t. Then again, it’s only an estimate. Your insurance company can at any time deny a claim if they feel it doesn’t fit within your plan’s outlined explanation of benefits.

Finding a More Predictable Option for Dental Coverage

An affordable alternative to traditional insurance is to enroll in a private dental savings plan. These discount programs offer fixed deductions on specific services, ranging between 10-60% in many cases. Although it’s not exactly the same thing as insurance, a dental discount plan works very similar. The benefits allow members to save on their treatment at both participating family dental practices and specialty clinics. And because there aren’t any claims to process, you know exactly what’s covered — or what isn’t — before you ever schedule the treatment. There won’t be any surprise bills in the mail! Contact today to find out how to enroll.

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