We diagnose and provide treatment using our best professional judgment rather than the cost of care. Employers and insurance plans often exclude coverage for certain necessary treatments as a way of reducing their costs. Even if we determine that a procedure is necessary for your overall oral health, your particular plan may not necessarily cover the cost of treatment.
You may have also noticed that your plan will only pay toward the least expensive alternative treatment. The reason they do this is obvious – to save money. For instance, we may recommend a dental crown while your insurance only offers a benefit toward a filling.
Of course, you’re not required to accept only a filling. The benefit paid will be the same, but your portion of the financial responsibility will be greater. It’s good to keep in mind that it is our job to prescribe the treatment that we know is best for your specific situation. It is the insurance carrier’s responsibility to control payments.
If you’re concerned about coverage for a particular procedure, it’s always best to contact your insurance company. Your insurance coverage is a contract between you, your employer, and the insurance carrier, and you are ultimately responsible for the total cost of your dental treatment.