Dental Insurance & Benefit Plans FAQ
Understand Your Dental Benefits – Guidance from Strickland Family Dentistry in Sarasota
A dental benefit plan helps cover the cost of dental care. While many refer to it as "insurance," it functions differently from traditional health insurance. These plans typically:
- Fully cover preventive services like cleanings and exams
- Partially cover procedures like implants or crowns
- May exclude elective or cosmetic services
Treatment decisions should always be based on your health—not just your insurance coverage.
Most dental plans involve cost-sharing between the patient and the insurer. They are often provided by employers but can also be purchased individually. At Strickland Family Dentistry, we help you navigate your benefits and provide clear cost estimates.
No. Your dentist recommends care based on your health—not your plan’s limitations. Coverage is based on what your employer or plan provider agrees to cover. Some treatments might not be covered even if necessary.
- Deductible: The amount you pay out-of-pocket before your plan pays
- Coinsurance: The percentage split between you and the plan after your deductible
- Annual maximum: The total your plan will pay per year (usually $1,000–$2,000)
If your treatment exceeds the maximum, you are responsible for the balance.
Some plans won’t cover conditions that existed before coverage began. For example, if you were missing a tooth before your plan started, it may not cover a dental implant to replace it. We can help you explore alternative options like dentures or bridges if needed.
If you have more than one dental plan (e.g. your own and a spouse's), they may coordinate benefits. However, this doesn’t mean both will pay 100%. Plans usually cover no more than 100% of the total cost together, and rules vary.
Plans may limit how often certain procedures are covered. For example, cleanings may be covered twice a year. If your oral health requires more frequent cleanings, you may need to pay out-of-pocket. We'll always advise based on what’s best for your long-term health.
Plans may deny claims not deemed “dentally necessary.” This doesn’t mean the care isn’t important. You can appeal the decision, and we’ll provide documentation to support your case.
- Bundling: Combining two procedures into one code
- Downcoding: Substituting a lower-cost procedure for the one performed
- LEAT (Least Expensive Alternative Treatment): Plan pays for the cheaper option
- Non-covered procedures: Services not covered at all (often cosmetic)
We always recommend the best care—even when plans opt for the cheapest route.
Review your benefit summary or speak with your plan provider. You can also contact our office and we’ll help verify your benefits and pre-authorization requirements before treatment begins.
No. Your oral health should never be limited by insurance coverage. Our team will always recommend the most effective and lasting treatments—even if they fall outside plan guidelines.