Dental Insurance – My Dentist’s Treatment Plan Goes Over My Yearly Limit! What Should I Do?


Many dental patients sign on the dotted line when they begin treatment and later find out that their dental insurance will not cover the full cost or as much of the treatment as they expected. Most dental plans allow for a yearly limit of between $1000 and $2000. If the cost of the treatment you receive exceeds the yearly limit that your plan allows, you should know beforehand so that you can make other arrangements.

When visiting the dentist, find out exactly how much it will cost. Sit down with the office manager or the person in charge of insurance and billing to find out what each procedure will cost. Before you sign for treatment to begin, check with your dental insurance plan to see what costs are covered and how much they will pay for your entire treatment plan. Once you agree to a treatment plan, and allow your dentist to complete treatment you are liable to pay no matter what your insurance does not cover.

Payment Options

There are some dentists that will agree to a payment plan that will allow you to pay off your dental bill in installments. If in your case your treatment exceeds the yearly limit and treatment is necessary to keep your teeth in good shape, sit down with the dental team that handles payments and come up with a plan that will enable you to pay off your bill at a monthly price that is acceptable both to you and the dentist. There are also third party credit solutions available that are specifically geared to help people with dental costs. Your dentist can often help you find these. You can also go online to find a bank that is willing to lend you the money. Care Credit is one such company that extends credit for those in need of medical or dental care whether they have insurance or not. There are a variety of plans that can be looked into to find out which plans are best for your needs and your dentist’s requirements.

If your dental treatment is considered a medical necessity then you have the right to appeal to the medical part of your insurance plan to pay for treatment above and beyond what your dental insurance will cover. This will only work if your dental treatment is truly a medical necessity.

The Bottom Line

When going to the dentist and offered a treatment plan, be sure that you have the coverage before you start. If not, discuss the treatment priorities. Sometimes certain procedures can wait for the next insurance coverage period. If you are in no pain or if delayed treatment will not cause further treatment to be needed, you can often wait until your next year’s limit comes around. Though no dentist will advise you to wait, you are the only one who knows what your entire situation is and what you can reasonably afford. The dentist will have your oral health in mind so don’t be afraid to sit down with him or her and the staff. Your dentist has your best interests at heart and will work with you in any way they can in order for you to get the proper treatment you need and to make sure that your insurance benefits are maximized.

Source by Steven Brazis