Medical Billing

Medical Billing and RCM Experts

what to do if dental insurance is maxed out

What To Do If Dental Insurance Is Maxed Out: Ultimate Guide

Insurance coverage is such a relief in this time of expensive dental treatments. But many times a few services charge out of your insurance and thus it makes you pay more than expected. However, our guide on what to do if dental insurance is maxed out will save you from financial hardships.

Receiving constant dental treatments within years utilizes insurance coverage faster. You will end up paying from your pocket because any time your dental bill may exceed your insurance coverage. 

Healthcare providers do their best to make payments easy for you but they unfortunately have to charge you directly instead of the insurance company. Because when they contact your insurance payer, and get the reply that you have utilized your coverage, any services exceeding coverage will be charged.

So here we will dive into this complicated yet crucial topic of dental insurance and your coverage limit. Let’s see your options when insurance is maxed out.

Understanding Your Dental Insurance

dental insurance

Insurance is an umbrella that protects you from paying heavy bills. But as a layman patient, you might not understand the intricate world of dental insurance and how it works. Let’s explore this topic and make you aware of the things you must know about.

What Does Dental Insurance Typically Cover?

Most of the dental insurance usually covers three types of services: 

Preventive Care: Routine examinations, cleanings, X-rays, and fluoride treatments. Preventive care is usually fully covered by insurance, which promotes routine visits to keep teeth healthy and identify problems early.

Basic Procedures: These consist of periodontal therapy (for gum disease), fillings, and extractions. Usually, these services have between 70% and 80% coverage.

Major Procedures: Crowns, bridges, dentures, and occasionally root canals fall under this category. Major operation coverage often hovers around 50%.

What is the Annual Coverage Limit?

Almost all dental insurance providers cover services received within a span of a year. This ranges typically from $1,000 to $2,000, but this amount may vary depending on your provider or geographical location. 

In simple words, you can get any dental service on insurance for up to $1000 or $2000 in a year. But for any additional service exceeding this limit, it will be on your side.

How to Know If Your Insurance Is Maxed Out?


Usually, as a patient, you wouldn’t know how much insurance you have left and what more services you can take. Eventually, you will end up asking yourself what to do if dental insurance is maxed out?

But here are some tips that will help you keep an eye on your insurance limit so that you never exceed them.

Review Your Insurance Policy

To find out the maximum yearly coverage amount, check your policy. This represents the annual maximum that your insurer will cover.

Monitor Your Usage

Your insurance company should send you an EOB each time you make a claim. This document lists the services rendered, the cost, the services the insurance covered, and the advantages you still have.

Numerous insurance companies provide real-time web portals for you to track your claims and leftover benefits. Regularly log in to keep an eye on your usage.

Contact Your Insurance Provider

To find out more about your remaining coverage and current benefit usage, contact the customer care number listed on your insurance card.

Do you Know What Happens When you Don’t Pay the Bill at All?

Find out how much is left on your yearly limit and whether there are any outstanding claims that could affect the amount of coverage you have left.

Communicate with Your Dental Office

Make sure your dental clinic has verified your insurance coverage before scheduling any procedures. They are able to verify your present insurance company status.

Understand Policy Limits and Exclusions

Certain rules have restrictions on which services can be provided (for example, only two cleanings per year). Ensure that you understand these limitations. 

Additionally, there are some signs that will help you know you are close to your insurance policy limit. In that case, you will be receiving more EOBs indicating high usage. 

Also, if you have recently received or plan to get high-cost services soon like crowns or root canals then it will utilize a high portion of your coverage.

What To Do If Dental Insurance Is Maxed Out? Quick Steps To Take

tensed lady calling

Unfortunately, if your dental insurance is maxed out, you don’t have to worry. There are still some options you can explore for a smart step towards your dental bills.

Confirm Your Coverage Status

Verifying that you have truly used up all of your dental insurance is the first step to take with your insurance company. 

Call your insurance provider and get a thorough explanation of your current benefits situation. Ask for a list of any outstanding claims that may have an impact on your coverage. 

Communicate with Your Dental Office

Talking with your dentist’s office about the matter is the next step after you’ve verified your insurance status. Notify the billing department of your dentist that your insurance has reached its maximum amount. 

They will assist you in understanding the out-of-pocket expenses for any impending therapies because of open communication. 

Explore Payment Options

Numerous dental practices provide a range of payment options to help you budget for treatments over time. Ask about these choices if you want to pay the bill over a few months. 

Know the Impact of Unpaid Bills on Your Credit

Consider Alternative Coverage

It may be helpful to look into extra dental insurance if your current policy is fully covered. Beyond the restrictions of your primary plan, supplemental insurance can help pay unexpected costs and offer additional coverage. 

Dental discount plans, on the other hand, might also be an affordable option. These plans provide lower rates on dental services in exchange for an annual fee. 

Utilize Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs)

You can lower your overall dental costs by using pre-tax funds from your HSA or FSA to pay for necessary procedures. 

Prioritize Treatments

Prioritize treatments according to urgency in collaboration with your dentist. Prioritize necessary and urgent medical care and put off less important procedures until your insurance is renewed.

Even if your insurance is fully covered, some dentist practices may still provide preventive care at a discounted cost.

Negotiate with Your Dentist

Never be afraid to inquire about any savings your dentist may be offering for paying with cash or in full upfront. For an annual charge, several practices offer in-house membership plans that provide savings on services. 

Affordable Dental Care Options

dental care help

Dental healthcare sometimes gets very expensive even after insurance. But when insurance maxed out, then having multiple financial assistance options will help you out. Here are some possibilities to consider:

Community Health Clinics: A large number of nearby health clinics provide dental care at discounted costs or on an income-based sliding scale. These clinics offer people in need vital medical attention.

Dental Schools: Treatments at dental colleges are frequently less expensive. High-quality treatment is ensured by the student-supervised, experienced teachers providing services.

Dental Discount Plans: For an annual fee, these plans provide discounts on a range of dental services; they are not insurance. They can drastically lower the price of medical care.

Payment Plans: To help you better manage your finances, a lot of dentist offices offer payment plans that let you stretch out the cost of treatments over time.

Government Programs: Medicaid and CHIP, for example, provide dental coverage for qualified individuals and families at little or no cost, enabling them to receive necessary care.

Non-Profit Organizations: Through events or mobile clinics, several non-profits provide free or inexpensive dental care. Look for local groups to see what services are offered.

    Subscribe our newsletter to see latest published content.

    Managing Dental Costs

    Knowing what to do if dental insurance is maxed out is crucial because it could get you into serious financial issues.

    Imagine receiving a dental treatment expecting your insurance will cover the costs but then getting a medical bill for the whole service. Horrific right?

    So our guide will provide great help in handling your insurance and financial issues.