Why Dental Insurance Isn’t Covering Everything: Understanding Coverage Gaps

Ever wondered why your adult patients often get denied coverage for fluoride treatments? Or why insurance denials and coverage limits seem to be increasingly out of control? You're not alone.

Before diving into the reason behind these coverage gaps, let's take a quick look at the bigger picture. With medical insurance, the government enforces something called the Medical Loss Ratio (MLR), which limits how much profit insurance companies can retain. However, because dental insurance isn't mandatory, there are no similar regulations forcing dental insurers to prioritize patient care. This lack of oversight allows them to keep more of their profits, often at the expense of patients.

So why don’t adults receive coverage for fluoride treatments? It all comes down to profits. Every year, millions of patients decline treatments their insurance refuses to cover. Fluoride is crucial for adults, especially as we age and engage in habits like smoking, drinking, and eating foods that may harm our dental health. Yet, only about one in four patients gets coverage for fluoride.

Why do children get coverage? Government mandates require insurance companies to pay for pediatric dentistry, preventing them from hoarding profits on adolescent plans. Adults, on the other hand, don’t have the same protections, so dental insurers can reject fluoride claims without consequences.

The next time you see a denial, ask yourself: is this decision about patient care or profit? If you're tired of insurance companies deciding what your patients need, it’s time to consider EmpowerDDS. We can help you set up alternative plans that offer transparency and pay your office's regular cash fee schedule, ensuring your patients receive the care they deserve—without the hassle of traditional insurance.

Take control of your patients' care. Tired of insurance denials impacting treatment plans? EmpowerDDS offers transparent, patient-centered alternatives that ensure you provide the care your patients deserve.

Visit us to learn more: Your dental services as a subscription. - Empower DDS