Why Doesn't My Dental Insurance Cover My Work?

Here's the uncomfortable truth that surprises most patients: dental "insurance" isn't really insurance — it functions more like a coupon. Other insurance sectors protect you from catastrophic, unpredictable costs. Dental plans, by contrast, cap what they'll pay each year at an annual maximum that's typically between $1,000 and $1,500... Here's the part that should make you angry: those maximums have barely changed since the 1970s (source). To put that in perspective, $1,500 in 1973 had the purchasing power of roughly $9,000–$10,000 in today's dollars (source). Your dental insurance benefit hasn't kept up with inflation; it's frozen in a different era while the cost of everything else has risen, including the cost of providing dental care to our patients.

So what should you do?

Use your dental benefits when you have them, but think of them as a contribution toward your care—not a guide for what care you need. Whether your insurance covers a procedure does not determine whether that treatment is right for your health. The “experts” that review your dental claims are not dentists, have no dental education, and only follow a set of rules to decide if you should receive coverage or not. If a claim is denied, speak to your dentist to see if there is anything you can do to help get the claim approved; sometimes this involves both the patient and/or doctor reaching out.

If you've reached your annual maximum or treatment doesn't fit comfortably within your budget, don't assume you're out of options. Many dental offices offer financing or payment options, and treatment can often be prioritized or phased when appropriate. Talk openly with your dental team—we're here to help you understand your options and find a path forward that works for you.