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Do Discount Dental Insurance Plans Allow More Pre-existing Conditions Than Full Dental Insurance?

Discount Dental Insurance Plans, also known as a dental fee plan or a dental discount plan, offer varying levels of cheaper dental fees in exchange for payment at the time of service. They can be compared to full dental insurance, which offsets some or all of the dental treatment costs. Discount dental insurance plans are really not insurance (It's illegal to imply they are full dental insurance but the term is used by some consumers in search of a "cheap" dental plan.) A feature of discount dental plans versus insurance is what they will and won't cover. Discount dental plans will typically cover a wider range of treatments than even the best dental plans. For example: Do discount dental insurance plans cover pre-existing dental conditions? (Continued After Table...)


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CATEGORY DESCRIPTIONS FEES METRO AREA STATE
DIAGNOSTIC D0120 Periodic oral evaluation $33 National Sample NA
DIAGNOSTIC D0150 Comprehensive oral evaluation $53 National Sample NA
DIAGNOSTIC D0274 X-Ray: Bitewings-4 films $49 National Sample NA
PREVENTIVE D1110 Prophylaxis-adult $58 National Sample NA
RESTORATIVE D2140 Amalgam filling-1 surface, primary or permanent $88 National Sample NA
RESTORATIVE D2330 Resin-based filling composite 1 surface, anterior $108 National Sample NA
RESTORATIVE D2750 Crown-porcelain fused to high noble metal $760 National Sample NA
ENDODONTICS D3330 Molar (excluding final restoration) $780 National Sample NA
PERIODONTICS D4341 Periodontal scaling and root planing, 4 or more teeth, per quad. $181 National Sample NA
PROSTHODONTICS D5110 Complete denture-maxillary $850 National Sample NA


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There are a long list of pre-existing dental conditions that an actual dental insurance program may not cover but which would be treated under a discounted dental fee plan. For example, a missing tooth is a condition which is often excluded under either individual or employer-based dental plans.

And no matter what the particular cause of this type of dental problem, it's rare to get any coverage on a typical insurance-based dental plan. (It's conceivably possible to gain coverage if it somehow can relate to treatment of an overall medical condition, although in the case of a previously missing tooth, not often heard of.)

The key is that most discount dental "insurance" plans allow someone to schedule just about any type of named treatment, without worrying about the cause. Since it is a true discount plan for dental, there's really no limit to how much dental work can be done as long as it's paid for at the time of service, or through some type of dental financing plan. The catch is the services are typically those offered by the participating dentist, in his or her office. That means specialists not in the discount dental program aren't included, and sometimes fees generated outside the dentist office like lab fees and tests may not be included. The easiest aspect of the dentist's discount plan will be his own labor, followed by his administrative staff. The hygenist, which is a pretty high paid staff member may not be as easy to put on the discount dental plan, although discounted cleanings are usually part of this plan.

The table below lists some of the more common treatments available and their national full and discounted fees for comparison. To find the fees in your area, click on the table and you can enter your zip code for more exact figures.