Dodge Trouble With Your Dental Insurance

Chances are you don’t think about your dental insurance policy very often, at least, not until you need it. At that moment, you might find yourself full of questions about what’s covered, what’s not and what you’re on the hook for in terms of out-of-pocket payment—and you’re not in the mood for hassles or trouble with your dental insurance.

You’re not alone.

“Oftentimes someone will go along with healthy teeth, and then they’re suddenly told they need a crown or a root canal and they need to understand how it works,” said Julie Estess, director of claims and provider support for Starmount. “When you enroll, there isn’t a problem, but now you’ve got questions.”

The Starmount in-house customer service team has some tips on what to do when you have trouble with your dental insurance.

Review the Policy to Avoid Trouble With Your Dental Insurance

You almost certainly got some sort of communication about your dental plan during open enrollment from your dental insurance carrier, benefits administrator or HR adviser. The materials you have will help you understand what you’ve signed up for and provide information about when you can get checkups or treatment, what’s covered and what’s not.

Problems often come up when people try to get treatment outside of network coverage. “Most of the time when we get a call, people want us to help them understand what’s covered and how it changes if they go out of network,” said Brandy Thomas, call center manager at Starmount’s AlwaysCare Benefits. In most cases out-of-network treatment is going to cost more, because in-network discounts don’t apply to that provider. Read your policy carefully to understand what’s covered, especially before you go to a dentist who may not be in your network.

Know Your Options

When possible, get a predetermination before you get treatment, especially for major procedures. It’s similar to getting an estimate for work that needs to be done on your car after an accident. “The dentist office will file that estimate, and that avoids some of the surprises you might get on the back end,” Estess said. “It will tell you exactly what will be covered.”

Getting a predetermination takes about two weeks, Thomas said. This can be especially helpful if you’re facing a combination medical and dental issue, such as the removal of wisdom teeth. A doctor may recommend removal of one or two wisdom teeth, while a dentist may say all four should come out “as long as they’re in there,” which medical insurance is unlikely to cover.

Have Your Information Handy

If you’re still having trouble with your dental insurance or getting answers, gather the specifics about your claim and call your dental insurance carrier. Having all statements, bills and policy information ready before calling your customer service representative will help them help you better.

To help avoid those big claims, Estess said preventive dental care is key. Some group plans have a carryover option that rewards plan members and dependents who receive preventive care and stay under a certain threshold of claims by letting the members carry over benefit dollars into the next year. “Routine cleanings are very important to your health and can help avoid big problems down the road,” she said.


What Your Affordable Dental Health Insurance Plan Should Include

How to Pick Individual Dental Insurance

Gum Disease, Periodontal Disease or Gingivitis: What’s the Difference?

Mayo Clinic Dental Health Resources

*Hyperlinks to third-party websites are offered for informational purposes only. Starmount in no way controls, guarantees, endorses, sponsors or promotes these websites or their content.

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