Let’s be honest: reading through a dental insurance policy isn’t exactly most parents’ idea of a fun Friday night. Between the fine print, the deductibles, and terms like “annual maximums,” it can feel like you need a specialized degree just to figure out if a cleaning is covered.
If you’ve ever stared at an explanation of benefits (EOB) and felt your eyes glaze over, you’re definitely not alone. Insurance is complicated. Unfortunately, this confusion often leads to misunderstandings that can cost families money—or worse, cause them to delay necessary care for their kids.
At Adelberg Montalvan Pediatric Dental, our Long Island pediatric dentist wants to bust the biggest myths surrounding dental coverage so that you can maximize your benefits without the headache. Here are the top dental insurance misunderstandings and how our team helps you navigate them.
1. The Myth: “Dental Insurance Works Just Like Medical Insurance.”
This is probably the most common source of confusion. Most of us are used to medical insurance, where coverage kicks in after a deductible is met to protect us against catastrophic financial loss. If you break a leg or need surgery, medical insurance is there to cover the big bills.
Dental insurance works differently. It is actually designed more like a discount plan or a maintenance program. Its primary goal is to cover preventive care (like cleanings and exams) to stop problems before they start.
How Our Long Island Pediatric Dentist Helps
We focus heavily on prevention for our little patients. Our team will always break down exactly how your specific plan treats preventive care versus restorative care. We help you understand that using your insurance for regular dental checkups is actually the best way to “get your money’s worth” out of your premiums.
2. The Myth: “If My Child Isn’t In Pain, We Don’t Need to Use Insurance.”
Many parents think that if their child has white, shiny teeth and no complaints, they should save their insurance benefits for a “rainy day” or an emergency.
The reality? Most dental plans operate on a “use it or lose it” basis. You likely have an annual maximum (the most the insurance will pay in a year). If you don’t use that amount by December 31st, it resets. It does not roll over to the next year. Furthermore, most plans cover preventive visits at 100%. Skipping them means you are essentially throwing away benefits you’ve already paid for.
How Our Long Island Pediatric Dentist Helps
At Adelberg Montalvan Pediatric Dental, we send friendly reminders when your child is due for a cleaning. We help you track your benefit timeline so that you never leave money on the table at the end of the year.
3. The Myth: “Coverage Means Everything is 100% Free.”
It is easy to assume that having “full coverage” means walking out of the office with a balance of zero every single time. While this is often true for standard six-month cleanings and exams, it’s rarely true for other procedures.
Most plans follow a “100-80-50” structure:
- 100% coverage for preventive care (exams, X-rays, cleanings)
- 80% coverage for basic procedures (like fillings)
- 50% coverage for major procedures (like crowns or pulp therapy)
How Our Long Island Pediatric Dentist Helps
Transparency is one of our core values. Before we start any treatment beyond a standard cleaning, we provide a treatment plan estimate. We’ll calculate what your insurance is estimated to pay and what your out-of-pocket portion will be. No surprise bills here!
4. The Myth: “Going Out of Network Is Always Too Expensive.”
The terms “in-network” and “out-of-network” (OON) can sound scary. Many parents assume that if a dentist is out-of-network, insurance won’t pay a dime.
While staying in-network often offers the highest predictable savings, many PPO plans have generous out-of-network benefits. This allows you to choose a Long Island pediatric dentist based on quality of care and comfort for your child, rather than just a name on a list.
How Our Long Island Pediatric Dentist Helps
Adelberg Montalvan Pediatric Dental accepts many major insurance plans. Whether we’re in or out of your specific network, our administrative wizards will file the claims for you. We handle the paperwork so that you don’t have to fight with insurance companies on your lunch break.
5. The Myth: “I Don’t Need Pre-Authorization for Treatment.”
Have you ever had a procedure done, assuming it was covered, only to get a denial letter later? This often happens because a plan requires “pre-authorization” or “pre-determination” for specific treatments. This is the insurance company’s way of pre-approving the necessity of the work. Skipping this step can lead to denied claims, leaving parents with the full bill.
How Our Long Island Pediatric Dentist Helps
We are proactive. If your child needs treatment that might raise a flag with your insurer, we can submit a pre-determination request on your behalf. We want to know—and we want you to know—exactly what the financial picture looks like before your child sits in the chair.
Ready to Maximize Your Benefits and Avoid Pitfalls?
Don’t let insurance confusion keep your child from a healthy smile. If you have questions about your specific plan or need to schedule that “use it or lose it” end-of-year appointment, book at Adelberg Montalvan Pediatric Dental today. Our friendly staff is ready to verify your benefits and help you understand your coverage with our trusted pediatric dentist in Long Island.