Why didn’t insurance cover all of that?

An infuriating question, we know, but one with a somewhat logical answer. First, you need to look at dental insurance differently than just a provider of benefits. At its most elemental, insurance is a bet on your good health. You and/or your employer give an insurance company money, and the insurance company bets that you won’t need more than what’s been put in the pot.

Now, there are a lot of different kinds of bets and some require more or less cash on the table depending on the plan. For our purposes here, let’s focus on the most common dental bet.

Most dental insurance plans cover two cleanings a year, more than half (usually 80 percent) the cost of basic procedures like fillings and half the cost of major procedures like crowns, and will attach a deductible and a maximum dollar amount of benefits.

Now, remember, a dental insurance company is betting on your healthiness. If you go to the dentist twice a year and get your teeth cleaned and examined, chances are you are going to have good oral health. So, insurance companies want you to get your teeth cleaned, so much so that they’ll usually waive the deductible and pay 100 percent of the visit.

If you need a filling, OK, they’ll pay most of it – better to pay for a filling than something bigger, but they’ll want you to cover the rest and pay a deductible, maybe as a little encouragement to brush and floss. If it turns out you need something more expensive like a crown, then they’ll want you to put a little more skin in the game. The rationale is that if you have to pay half of a major procedure, you’ll be more likely to take better care of your teeth in the future. It’s all about managing the odds.

Of course, there are people who, for whatever reasons, need more dental care. For this reason, the insurance company will limit on what it will pay out annually, the size of which depends on which plan you and/or your employer choose and how much you’re willing to pay. In general, the bigger the annual maximum, the bigger the up-front price.

Now, if all this sounds frustrating, take some comfort in the fact that dental insurance companies literally have a vested interest in your good oral health. They want you to have clean teeth and a healthy smile.

Which, is something we all have in common.

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