Use your insurance don’t let it use you

Dental insurance operates quite differently from traditional medical insurance. If you’ve ever felt confused or frustrated by your dental coverage, you’re not alone. In this short article, we’ll help clarify how dental insurance works and share tips on how to make the most of your benefits.

3 Key Differences with Dental Insurance Plans

1. Focus on Prevention, Not Treatment

Most dental insurance plans today are designed to cover preventive care for your child—such as cleanings, exams, and X-rays—rather than extensive dental treatment. Preventive services are usually covered at 80–100%, while procedures like crowns or implants are often covered at only 0–50%.

2. Choosing Your Dentist

The majority of PPO dental insurance plans allow you to choose your own dentist. However, some insurance companies may try to steer you toward their preferred “in-network” providers. These in-network dentists have signed contracts that help the insurance company save money—often at the expense of your out-of-pocket costs or even the quality of care. Being “in-network” doesn’t necessarily mean you’re getting better coverage.

3. Annual Maximums Haven’t Kept Up with Costs

Most dental insurance policies include a fixed annual maximum—the total amount the plan will pay per year. Whether you need no treatment or $10,000 worth, the insurance company’s contribution is capped, typically around $1,500 per year. Shockingly, that amount has remained unchanged since dental insurance began in the 1950s, even though the cost of care has risen dramatically over the decades.

How to Maximize Your Dental Insurance Coverage

1. Choose the Right Pediatric Dentist

The best dentist for your child may not be the one recommended by your insurance company. Remember, insurance providers prioritize their shareholders’ interests—not your child’s oral health. Both overtreatment and undertreatment can be harmful, so finding a balanced, trustworthy provider is key.

Not sure if you’ve chosen the right pediatric dentist? Don’t hesitate to ask questions, educate yourself, or even seek a second opinion. A reputable pediatric dentist will recommend the same care they’d provide for their own child—nothing more, nothing less. That means your child’s oral health is the top priority, not an insurance contract.

2. Stay Proactive with Preventive Care

Preventive services are typically covered at 80–100%, making them the smartest way to use your benefits. Regular cleanings, fluoride treatments, and sealants on permanent molars are great examples—they’re often fully covered and help prevent future problems like cavities or costly fillings and crowns.

3. Request a Pre-Authorization for Treatment

Before starting any major dental treatment, ask your pediatric dental office to submit a pre-authorization to your insurance. This helps you understand what’s covered—and prevents surprise bills due to coverage limits, frequency restrictions, waiting periods, or age caps.

Here are some more tips in understanding dental insurances.

We hope this article helps you better understand how to make the most of your dental insurance benefits. For more tips, check out our guide on how to maximize your coverage before the end of the year— it’s often called “use it or lose it.”

Here is another post if you are wondering why your insurance isn’t paying for a service.

Got questions regarding your dental insurance? Call us!

If you have any questions regarding your child’s dental insurance call our office and the team at Sorenson Pediatric Dentistry will help you to understand your dental insurance plan

Call us and schedule your child’s appointment today: (702)586-4347