Dental Insurance: Myths vs Facts


People think that their dental insurance policy will take care of major events like house or medical insurance will.


People who have “dental insurance” really only have minor dental benefits that are determined by their employer and an insurance company. A dental benefit is more like a coupon. It doesn’t pay for the entire product or service. It only pays a vague percentage and it has a maximum it will pay each year.


“Because I need this dental work, my dental insurance will pay for it!” or “My dental insurance will pay 80 percent of what I need to fix my dental problems!”


In 1972, most dental plans covered $1,000 to $1,500 per year, and most companies paid the premiums. At that time, crown fees were around $400 and insurance could, would and did pay for 80 percent. Basically, a patient could get three or four crowns a year to repair broken down, filled teeth and in a few years, their mouth didn’t need any more major work. Plus, the patient could get two cleanings a year and not even approach their insurance limits. That was a great deal for patients and dentists.

40 years later, most plans still have $1,000 to $1,500 annual limits, and many people are paying half or all of the premiums. Today’s crown prices have more than doubled so one or two crowns will basically wipe out a year’s benefit.

Consider the following comparison to car insurance:

In 1972, few cars cost more than $6,000. That’s what your auto insurance would pay if you totaled your car back then. If auto insurance stayed the same as dental insurance, they would only cover a bumper or fender repair in today’s car.

Past versus the Present

The real problem is that today’s dentistry is nothing like it was 40 years ago. If patients had dental problems, the choices were to pull, fill or crown the tooth. Today, we have dental implants, dental lasers, all porcelain crowns, zirconium based crowns, 3D CAT scans, TMJ treatment, cosmetic dentistry and the list goes on and on. Many of these procedures are not covered by the dental benefit contract or the procedures cost more than the yearly benefit.

Forty years ago, there was no such thing as Managed Care, no PPOs, HMOs, etc. These insurance companies find dentists that will cut their fees in order to be “on the plan.” It is a good marketing tool for the dentist because people naturally want to have the least expensive dental work possible.

To find a new dentist, they look at the provider list in making a choice for a new dentist. The dentist making the deal with the insurance company must cut their fees from 30-70 percent. Then, the plans pay the dentist a flat fee for every patient who calls them “their primary care provider.”

These dentists get virtually nothing for the routine care or treatment they provide. In order for them to make a return and still operate their business, they have to drastically cut overhead in some manner, and often, this means doing no treatment because to do the correct treatment actually costs them money.

There is definitely no focus on customer service like you will find at! Even though it is a managed care system, it is still acts as a coupon and not insurance.


“The dentist and dental team should know what a person’s dental benefit is and what it will cover and pay, and if the insurance company doesn’t pay, it’s their problem.


The dental insurance contract is between the employer and employee (the patient), and the insurance company. The dentist has no influence on what “should be covered”. The employer and insurance company negotiate these things ahead of time. The dentist is simply caught in the middle.

At, we love helping people. We try very hard to accommodate our patients and even hire extra people just to help the patients get the most they can. Out team has three full time employees whose entire job consists of trying to get our patients the most out of their plans possible.

At, we try as hard as possible to help people maximize their dental benefit but it is getting harder and harder to do. Ultimately, the financial responsibility for all dental treatment is the patients.

A Final Word About Dental Insurance

The insurance companies did not build all the skyscrapers in New York, Chicago, etc because they lose money. They created the system so they can make a profit.The best approach if you do have insurance is to just think of it as a coupon and not something that is going to pay for major dental problems.

If your company is paying for it, then it is a true benefit but will not pay for everything you might think it should. If you are paying for it, you might want to look at what you are paying and exactly the benefits you are getting.

And finally, over and over we see patients who “only do what the insurance covers.” This approach ends badly. By letting the insurance dictate treatment instead of the dentist, the care that patients get is never ideal, and almost always ends up with the patient needing more dental treatment than otherwise would be.