"My dentist recommends a treatment that my plan will not pay for. Does this mean the treatment really isn’t necessary?"

It is common for dental plans to exclude treatment that is covered under the company’s medical plan. Some plans, however, go on to exclude or discourage necessary dental treatment such as sealants, pre-existing conditions, adult orthodontics, specialist referrals and other dental needs. Some also exclude treatment by family members. Patients need to be aware of the exclusions and limitations in their dental plan but should not let those factors determine their treatment decisions.

"My dentist is not on the list of dentists provided by my employer. Can I still go to
him/her for treatment?"

You can always go to the dentist of your choice. The question is whether or not you will have benefit coverage for the treatment you receive if it is provided by a dentist who is not on the plan’s list. This depends on the contractual agreements between the plan purchaser (often your employer), the dentists on the list, and the plan administrator. Under certain contracts, such as PPO (Preferred Provider Organization) program, patients are given a financial incentive to go to certain dentists but do receive some level of dental benefit, regardless of the treating dentist. Other plans, such as capitation programs, do not provide any benefit coverage for treatment given by “non-participating” dentists. In all instances, where this type of plan is offered, patients should have the annual option to choose a plan that affords unrestricted choice of a dentist, with comparable benefits and equal premium dollars.