Why Doesn’t My Dental Insurance Cover This

August 17, 2018

Dental plans differ from general health insurance. Based upon agreements made between employers and insurance companies, the amount covered by dental plans varies depending on how much employers pay into their dental plans and the coverage guidelines set within dental plan agreements. No standard for dental coverage exists; coverage varies greatly between plans, employers and coverage levels.

Common Dental Plan Terms to Know

When reviewing your own dental plan and coverage options, it's helpful if you are familiar with the jargon commonly used in insurance documents. Understanding these terms will help you decipher what coverage you have access to and how much you can expect to owe out of pocket on your dental bills.

  • Usual, Customary and Reasonable (UCR) Charges – These are the fees for various services deemed acceptable by your dental plan. They are the amounts off of which coverage is based. UCRs are not always updated regularly and are not necessarily based on regional numbers. As a result, they often do not reflect actual fees in your area.
  • Least Expensive Alternative Treatment (LEAT) – Plans that have a LEAT clause only pay for the least expensive treatment option available, when more than one option is provided.
  • Not Dentally Necessary – Some plans have a list of treatments recognized as necessary. If a treatment is not on this list, it might not be covered – even if the treatment was medically recommended.
  • Annual Maximums – The maximum a plan will pay in a year.
  • Pre-Existing Conditions – A plan might not cover a condition which existed before your enrollment date.
  • Preferred Providers – Some plans require patients to choose from a list of providers who have a contract with the insurance company to provide care at lower cost.

Choosing Dental Care to Fit Your Dental Plan

With the complications of dental plans and budgets, it can sometimes be difficult to know which treatment course is best for you or your family. We don't recommend relying on what your dental plan deems “dentally necessary" to make decisions regarding your own healthcare.

At Schaffer Dental Excellence, we strive to help each patient achieve the best dental health possible, preserving smiles and safeguarding health for life. We work with each patient to devise the best individual treatment plan based upon their dental needs. We also work with patients to help them better understand their dental coverage and the cost of treatment. We always welcome patients to contact our office with any questions regarding dental plans or our services.