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August 13, 2025
Understanding Patients' Benefits Prior to Treatment: Important for Your Office AND Your Patients

Dental coverage is a great benefit that is proven to improve oral health by making dental care more affordable. However, it's not designed to cover every dental service.

What happens when you perform a service that is not covered by your patient's dental benefits program?

Patients often believe a service is covered if you provided it. Unless you've discussed this with your patient in advance of providing the service, chances are a misunderstanding will arise. That's why it's important to make patients aware of optional and noncovered services.

At Delta Dental, patient education is a top priority. You can play a key role as well. Making your patients aware of the payment policies associated with their coverage (including all options available for a specific dental treatment and their respective costs) will save you and your staff time and help you maintain good relationships with your patients.

What You Can Do To Understand Your Patients' Benefits

  • Understand optional services. Delta Dental offers an array of dental benefit plans to employers. The benefits provided to employees depend on the plan options the employer selects. Payment policies differ for each program and likewise, not all treatments are covered similarly. Depending on the treatment, Delta Dental will pay only the applicable percentage of the fee for the maximum plan allowance for that service.

For example: If a tooth can be restored with a material such as amalgam, but the patient and dentist select another type of restoration, such as posterior resin, payment based on the applicable percentage of the maximum plan allowance for the amalgam will be made toward the fee of the alternative restoration.

As you know, in-network or out-of-network dentist selection also determines coverage level.

  • Predetermine services over $200. It is beneficial to predetermine any services over $200 to avoid confusion or a misunderstanding over what a patient owes you. This way, you and your patient know up front how much will be covered under the benefit program and how much the patient will be required to pay for the service.
  • Help your patients understand their benefits. Clearly, it is impossible for you and your staff to memorize the intricacies of each and every dental benefit program. However, you could ask your patients to bring their certificate of coverage and any other information they have regarding their dental program with them when they come to your office for an appointment. You can make a copy of the information and then have it accessible when they need it most – at your office.

Helping patients understand optional and noncovered services prior to the procedure is an important step in their treatment – make sure you and your patients are informed as possible.