Dental insurance can help make private dental care more affordable, but understanding what your policy covers isn't always straightforward. From annual benefit limits and excess payments to pre-authorisation and claiming for treatment, there are several things worth checking before your next dental appointment. In this blog, I'll explain how dental insurance works, what to look out for and how to make the most of your dental benefits while looking after your oral health.
Dental insurance: what do you really need to know?
One question patients sometimes ask is whether having dental insurance means their dental treatment will be free.
Whilst that may be the case, for some that may also be wishful thinking! The answer is that it depends on your individual policy - schemes can vary, depending on how much your cover gives.
Dental insurance can be a helpful way to manage the cost of looking after your teeth, particularly if you visit your Dentist regularly or need treatment during the year. However, different policies offer different benefits, and understanding the details can help you avoid unexpected bills.
If you have dental insurance through your employer, or you've taken out a personal policy, here are seven things I'd recommend checking before your next appointment.
1. Understand exactly what your dental insurance covers
Not all dental insurance policies are the same.
Some focus on routine preventative care, while others contribute towards a broader range of treatments, potentially including fillings, crowns, root canal treatment and emergency dentistry.
Depending on your policy, you may also have benefits towards dental hygiene appointments and dental X-rays.
Before booking, take a moment to check your policy documents. Look for the treatments included, any exclusions and whether particular procedures require additional approval.
For example, your policy might contribute towards a routine examination but have different limits for specialist treatment or more complex procedures.
My advice: Don't assume that a treatment is covered simply because it's carried out by a private dentist. If you're unsure, ask your insurer to confirm your benefits in writing.
2. Check your annual allowance and benefit limits
Many dental insurance policies have an annual benefit limit. This is the maximum amount your insurer will contribute towards eligible treatment during a specified period.
Some policies also set individual limits for different categories of treatment.
Imagine your policy provides a set allowance for routine dentistry and a separate allowance for more complex treatment. If you need several procedures during the year, you may find that your available benefits change as you make claims.
It's also worth checking when your insurance year begins and ends. This may follow the calendar year, your policy renewal date or another arrangement.
Understanding these limits can help you plan ahead and make informed decisions about your dental care.
However, me, or any Dentist, wouldn't recommend delaying clinically necessary treatment simply to wait for a new insurance year. If treatment is recommended, discuss the clinical implications of waiting with your Dentist.
3. Find out whether you need to pay an excess or contribution
An excess is an amount you may have to pay yourself before your insurance contributes towards eligible costs.
For example, if your policy has an excess, you may need to cover that amount even when the treatment itself is eligible for reimbursement.
Other policies may reimburse only a percentage of the cost, up to a maximum benefit.
This means that two patients receiving the same treatment could receive different levels of reimbursement, depending on their individual policies.
Before starting treatment, make sure you understand:
Whether your policy has an excess.
Whether you must contribute towards treatment costs.
Whether reimbursement is based on a percentage of the fee.
Whether there is a maximum amount payable for each procedure.
This information can help you budget and avoid surprises when your claim is processed.
4. Check whether your insurer requires pre-authorisation
Some insurers require you to obtain approval before certain treatments begin. This is often called pre-authorisation or pre-approval.
It may be particularly relevant when treatment is more complex or expensive (it is rarely needed for basic things like check ups, hygiene and fillings etc - but check!)
For example, if your Dentist recommends a crown, root canal treatment or another procedure, your insurer may ask for a treatment plan, an estimate or supporting clinical information before confirming the benefits available.
Pre-authorisation can help you understand what your insurer is prepared to contribute, although it is important to check whether the confirmation is final and whether any conditions apply.
If your insurer requires approval, make sure you understand the process before agreeing to treatment.
At tooth, we can provide relevant invoices and supporting documentation to help with your insurance claim. We can even fill out and stamp and sign forms for those dental insurers that still have them.
5. Know how to claim for your dental treatment
Another common source of confusion is how the payment and reimbursement process works.
Depending on your insurance arrangements, you may need to pay your dental practice directly and then submit a claim to your insurer. This is the normal way of working for the vast majority of insurers but other arrangements may work differently.
Your insurer will explain how to submit a claim and which documents are required.
These might include:
An itemised invoice showing the treatment provided.
A receipt confirming payment.
A treatment plan or estimate.
Additional clinical information requested by your insurer.
Keep copies of any documents you submit and check whether your insurer has a deadline for making claims.
If you have dental cover through your employer, you may also need to follow a particular process or use a specific claims portal.
It's always worth checking the details before your appointment rather than waiting until you've received your bill.
6. Don't forget the importance of preventative dental care
When people think about dental insurance, they often focus on what happens when something goes wrong.
But from a dental health perspective, one of the most important things you can do is attend regular examinations and look after your teeth and gums between appointments.
Routine dental examinations allow your Dentist to assess your oral health, identify potential problems and recommend treatment where appropriate.
Professional dental hygiene appointments can also help manage plaque, tartar and gum health, alongside effective brushing and cleaning between your teeth at home.
Your insurance policy may include benefits towards some preventative appointments, although the frequency and amount covered will vary.
Even if your policy doesn't cover every appointment in full, don't overlook the value of preventative care. Identifying a problem early can sometimes mean that treatment is simpler than if the condition is allowed to progress.
The right recall interval will depend on your individual oral health and your dentist's recommendations.
7. Check your options if you change jobs or dental practices
If your dental insurance comes through your employer, it's worth checking what happens if you change jobs or your employment benefits change.
Your cover may be linked to your employment, and the terms could change when you leave the scheme.
Similarly, if you move to a new area or decide to change dental practices, check whether your policy allows you to attend your preferred Dentist and whether any registration or referral requirements apply.
If you're already receiving treatment, ask your insurer how a change in cover might affect planned appointments or outstanding claims.
It's much better to understand these details in advance than to discover that your circumstances have changed when you need treatment.
What if I need dental treatment but I'm not sure whether my insurance will cover it?
This is something you can discuss with both your insurer and your dentist.
The first step is to establish what treatment you need. Your Dentist can examine your teeth and gums, explain any findings and provide recommendations based on your clinical needs.
If further treatment is required, ask for a written treatment plan and an estimate of the fees.
You can then share the relevant information with your insurer and ask them to confirm the benefits available under your policy.
Remember that your insurer's decision about reimbursement and your dentist's clinical recommendations are two separate things. Your dentist's priority is to advise you on the treatment appropriate for your oral health, while your insurer determines the benefits available under your policy.
If a treatment isn't fully covered, your dentist can explain the costs and discuss any clinically appropriate alternatives.
What about dental payment plans such as Denplan?
Dental insurance and dental payment plans are related, but they aren't necessarily the same thing.
Dental insurance generally provides benefits towards eligible costs under the terms of an insurance policy. A dental payment plan, like Denplan, may instead help you spread the cost of specified dental care through regular payments.
Some arrangements combine different benefits, so it's important to understand exactly what your particular plan includes.
At tooth, we offer Denplan arrangements, including Denplan Essentials, Denplan Care and Denplan Corporate options. The benefits, eligibility and terms depend on the relevant plan.
If you're considering a dental payment plan, ask what routine care is included, whether additional treatment costs apply and whether any insurance benefits are provided.
You can find more information on our Dental Insurance and Denplan page.
Final thoughts: make your dental benefits work for you
Dental insurance can be useful, but the key is understanding your policy before you need to make a claim.
Check your benefits, keep an eye on annual limits, understand any excess payments and find out whether you need pre-authorisation for treatment.
Most importantly, don't let uncertainty about insurance put you off seeking dental advice. If you're worried about a tooth, experiencing pain or overdue for a check-up, speak to a dental professional about your options.
At tooth dental care in Waterloo, London, we're happy to help patients understand the practical steps involved in arranging appointments and obtaining the documentation they need for their insurance claims.
If you'd like to know more about using your dental insurance at tooth, visit our Dental Insurance and Denplan page or contact our friendly team.
And remember, if you have any questions at all, our team at tooth is ready to help - and always super-easy to contact too! Just click on any of the buttons below, or check out the dental insurance FAQs below.
Dr Anna x
Frequently Asked Questions
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Whether dental insurance is worthwhile depends on the cost of the policy, the benefits included and your individual dental care needs. Compare the annual premium with the treatments covered, benefit limits, exclusions and any excess payments before deciding.
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This depends on the insurer and the terms of your policy. Some policies may exclude pre-existing conditions or treatment that was already recommended before cover began. Check the policy wording and ask your insurer if you're unsure.
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Some policies allow you to claim reimbursement after paying your dentist, provided the treatment is eligible and you meet the insurer's requirements. Check the claims procedure, documentation requirements and submission deadlines.
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An excess is an amount you may have to pay yourself under your policy. An annual limit is the maximum amount your insurer will contribute towards eligible treatment during the relevant insurance year. Your policy may include both.
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Some policies require pre-authorisation for particular procedures, while others allow you to claim without obtaining advance approval. Check your policy before starting treatment, especially if a procedure is complex or expensive.
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Dental insurance generally contributes towards eligible treatment costs according to an insurance policy. Denplan offers dental payment plan arrangements that can help patients budget for dental care. The precise benefits and terms depend on the particular plan.
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No, not without discussing it with your Dentist. Although benefit limits may renew at a particular time, delaying treatment could allow a dental problem to worsen. Ask your Dentist about the clinical implications of waiting and discuss your financial options.
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Ask your dentist for details of the recommended treatment and estimated fees, then contact your insurer with this information. The insurer can explain whether the treatment is eligible and what benefits may be available under your policy.