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Common Problems With Dental Insurance

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Dental insurance is designed to help individuals and families manage the costs of maintaining good oral health. However, navigating dental insurance plans can be challenging, and many people face various issues when trying to use their coverage effectively. In this article, we’ll explore eight common problems that people encounter when using their dental insurance, providing valuable insights for those curious about how dental insurance works and what to expect when utilizing their benefits. Even though Novudentics doesn’t accept Dental Insurance as a form of payment, we still think its important to educate people on common dental insurance issues you can face.

Limited Coverage

One of the most significant issues with dental insurance is that many plans have limitations on the types of procedures they cover and the amount they will pay for each procedure. For example, some plans may not cover certain treatments, such as orthodontics or cosmetic dentistry, leaving policyholders responsible for paying the full cost of these services out of pocket.

Additionally, even for covered procedures, insurance plans may only pay a portion of the cost, leaving the policyholder to cover the remaining balance.

Annual Maximums on Dental Plans

Most dental insurance plans have an annual maximum benefit, which is the total amount the plan will pay for dental care within a year. Once this maximum is reached, the policyholder is responsible for paying any additional costs out of pocket.

Annual maximums can vary widely between plans, with some offering relatively low maximums that may not adequately cover the cost of extensive dental work. This can be particularly problematic for individuals who require multiple or costly procedures within a single year.

Waiting Periods

Some dental insurance plans have waiting periods before certain procedures, such as crowns or bridges, are covered. This means that the policyholder may have to wait several months after enrolling in the plan before they can receive coverage for these treatments. Waiting periods can be frustrating for individuals who have immediate dental needs and can lead to delayed treatment, potentially exacerbating dental problems and increasing costs in the long run.

Dental Network Restrictions

Many dental insurance plans have a network of participating dentists. If a policyholder chooses to see a dentist outside of this network, they may have to pay more out of pocket or may not have any coverage at all.

This can be particularly challenging for individuals who have established relationships with non-participating dentists or those who live in areas with limited in-network provider options. As a result, policyholders may feel restricted in their choice of dental care providers or may face higher out-of-pocket costs to maintain continuity of care.

Deductibles and Copayments

Like health insurance, dental insurance plans often have deductibles (an amount the policyholder must pay before the insurance starts covering costs) and copayments (a fixed amount or percentage the policyholder pays for each procedure).

These out-of-pocket expenses can add up quickly, particularly for individuals or families who require frequent dental care. High deductibles and copayments can make dental insurance feel less valuable and may discourage some people from seeking necessary dental treatment.

Confusion About Dental Coverage

Dental insurance plans can be complex, and policyholders may have difficulty understanding what is covered, how much they will have to pay out of pocket, and which dentists are in their network.

This confusion can lead to unexpected costs and frustration when individuals discover that certain procedures are not covered or that they must pay more than anticipated. Navigating the intricacies of dental insurance can be time-consuming and may require assistance from insurance representatives or dental office staff.

Pre-Existing Conditions

Some dental insurance plans may not cover certain pre-existing conditions or may have a waiting period before covering these conditions. This can be problematic for individuals who have ongoing dental issues or who have delayed dental treatment due to financial constraints. In some cases, individuals may need to pay out of pocket for treatment related to pre-existing conditions, even if they have dental insurance coverage.

Paperwork and Claims Processing

Filing claims and dealing with insurance paperwork can be time-consuming and frustrating for policyholders and dental offices alike. The process of submitting claims, providing necessary documentation, and following up on delayed or denied claims can be complex and may require persistence and patience. Additionally, miscommunications between dental offices and insurance companies can lead to confusion and delayed payment, further complicating the claims process for policyholders.


Dental insurance is a valuable tool for managing the costs of oral health care, but it is not without its challenges. Common issues that people face when using dental insurance include limited coverage, annual maximums, waiting periods, network restrictions, deductibles and copayments, confusion about coverage, pre-existing condition limitations, and paperwork and claims processing difficulties.

By understanding these potential obstacles, individuals can be better prepared to navigate their dental insurance plans and make informed decisions about their oral health care. Open communication with dental providers and insurance representatives can help policyholders maximize their benefits and minimize unexpected out-of-pocket expenses.

Who Wrote This?


Dr. Kallithrakas (Dr. K) is the lead prosthodontist for Novudentics in Palm Beach, Florida. He obtained a Doctor of Dental Surgery (DDS) and conducted a one year fellowship in Implant Dentistry sponsored by Biomet 3i at NOVA Southeastern University. Dr. K also has a Master in Science in which his thesis The difference in microgap between zirconia and titanium abutments; a pilot study was published.

Dr. K and his team at Novudentics have extensive training in all areas of prosthodontics, and serve patients across the United States from his Palm Beach office location. He believes that changing someone’s smile can help make a difference in many aspects of someone’s life.

Connect with Dr. Kallithrakas on Linkedin.

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