Dental Insurance: What are the Common Exclusions in the Plan?

September 3, 2012

 

Getting a dental insurance plan may be a good decision; however, not everyone who owns one is happy that they do. It’s very unfortunate that there are some dental insurance companies that are not honest enough about the inclusion and exclusion of the plan coverage. Sometimes, there are hidden or unexplained restrictions that are stipulated somewhere in the documents but haven’t discussed to the insurance holders prior to their purchase of the plan. On the other hand, there are also many plan holders, especially those who paid for expensive plans, assume that theirs cover any dental procedure without validating their assumption with the insurance company. 

Dental insurance plans, no matter how expensive it is, have certain exclusions from the coverage. Here are the common exclusions: 


1.    Dental procedures in excess of the dental insurance coverage. If the dental insurance plan only covers two tooth filling procedures in a year, anything in excess of two will already be charged to the patient. 

2.    Experimental dental treatments and dental cosmetic procedures. Unless clearly stated in the plan, orthodontics is not usually covered by dental insurance plans. 

3.    Getting the service of a dentist who is outside the network of dentists approved by the insurance provider. 

4.    Dental treatments that are covered by other insurances – medical, dental, state insurance. 

5.    Dental counseling and cleaning supplies. 

6.    Ambulance charges, prescription drugs, hospitalization, and anesthesia. 

7.    Dental treatments that have been performed prior to the purchase of dental insurance plan; unless stated in the plan. 

8.    Anything not listed in the plan. 

Individuals who are planning to purchase a dental insurance plan must make sure that they understand everything that is written in the policy, specially the inclusions and exclusions to avoid problems in the future. Also, making sure that the plan is worth paying for is wise.

 

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