Many of our Houston patients have dental insurance, but when it comes to understanding your policy, there are many different stipulations that determine whether or not your plan will help pay toward a procedure.  Even within the same plan, a treatment that is covered for one person doesn’t necessarily mean it’ll be covered for the next. To help you better understand your dental insurance benefits are, here is an explanation of some of the conditions that your plan may have:

Waiting Period

If you’re looking for a dental insurance plan because you need to have some dental work done then you should check for a clause known as the “waiting period”.  Many policies will state that you must have their plan for a certain amount of time before they will cover any “major dental work”. Dental crowns and root canal therapy are a couple of procedures that fall into this category. The time frame for a waiting period can be as short as three months, or up to one year.

Frequencies/Replacement Policy

When you have a certain procedure done, like a filling for example, your plan won’t pay for another one on that same tooth for a certain period of time. 

Some common frequencies include two cleanings per year, a replacement crown every five years, or a set of bitewing x-rays once per year. If you have any of these procedures done prematurely, your insurance claim can be denied. In addition, when submitting a claim for a replacement crown, partial, or denture, the insurance asks when the current dental work was performed.

Missing Tooth Clause

Another stipulation that some dental insurance policies have is a missing tooth clause. This comes into play when you want to replace a missing tooth.  If your policy has this clause then they won’t cover the cost of replacing a tooth that was pulled prior to your having your current policy.

Cosmetic Procedures

Treatments that aren’t necessary are considered cosmetic.  These procedures include services like teeth whitening and porcelain veneers. As a general rule, elective therapies are not covered by dental insurance policies.


Dental Implants

Some insurance companies still consider dental implants to be elective or cosmetic, and won’t cover the cost.  However, others do realize the overall benefits of implants and have started contributing their share.

Fluoride Treatments

Fluoride treatments are used to fight cavities and reduce tooth sensitivity in both children and adults. Typically insurance plans will cover fluoride treatments in children but for some reason, they deny ones for adults.  However, the benefits of having fluoride done is well worth the minimal cost, and the procedure is affordable enough that paying for it out of pocket won’t break the bank.

Get Help Understand Your Dental Insurance Benefits

If at any time you have any questions about your insurance policy and what it covers, North Houston Dentistry can help.  We can also work with you to maximize your benefits to get you a healthy smile and keep it that way. Come visit our best Houston family dentist today to learn more. We look forward to meeting you!