Why Does My Dental Insurance Not Cover That? (continued)

This is the fourth chapter in the series which is intended to provide some clarity regarding dental insurance coverage.

There have been times when a patient has been very excited to use new dental insurance. If it had been a long period of time since that patient received dental care, there may have been some “catching up” to do.

A common occurrence can be that the patient is told that a  more extensive cleaning is required to get back on track. If the situation is not too far advanced, it may be that a second cleaning appointment is necessary. The longer the stain and “tartar” has been present, the longer it takes to get it all removed. (A little bit like the difference between washing your car once per month, or only once per year.)

Again, due to the differences between dental plans, sometimes the second cleaning will be covered, and sometimes it will not be covered. Some plans will cover two cleanings any time over the twelve months of the plan; once two cleanings have been submitted, the policy will not cover any more cleanings until the plan renews. This can be disappointing when, six months later, the patient goes in dutifully for a regular cleaning, and the insurance will not pay for it. Another twist to the rules will arise when a plan will only cover a cleaning when six months have passed since the last cleaning. In that case, the second appointment to get the patient back on track will be denied; however the next six month cleaning will be covered providing six months have passed. In either of these cases, patients have been disappointed because they thought all cleanings were “free” (no out of pocket expense).

If a greater amount of time has elapsed since a patient had regular care, the damage could be greater. There may be the start of some bone loss, and infections present in the gum tissue. This type of condition could require more than one extra visit for a cleaning. The need for a “deep cleaning” (scaling and root planing) would be explained, and the amount of time and the fees involved. It is necessary for the dentist or the hygienist to do a good job in explaining this procedure; it is something beyond a routine cleaning. If a patient decided not to accept the treatment, that patient would start a long, downward spiral which will eventually end in tooth loss. At times, some patients have been tempted to ask if it was possible to forgo the deep cleaning, and do a simple cleaning instead. A well trained hygienist and dentist will know that providing a simple cleaning at that point would be akin to putting a band aid on a broken leg; it just won’t work.

When you experience some disappointment regarding a “denied dental claim” it will be important to remember that you and your dentist are partners in deciding your dental future. After all, what else can impact your life as much regarding your enjoyment of meals, your conversations, your smile and, don’t forget, your kiss!

Stay tuned for more about your insurance.