Taking care of your oral health is a team effort. That team includes you, your dental care providers, and your dental insurance. But understanding who does what can sometimes be confusing.

Each player has a unique and important role when it comes to keeping your smile healthy.  Knowing the difference between them can help you feel confident about where to turn when you need care.

We’ve broken down the roles of your dental care provider team and your dental insurance, so you’re prepared the next time you need support for your oral health.

Who are dental care providers?

Dental care providers are licensed professionals who deliver the clinical services you need to maintain and improve your oral health. This team may include:

• Dentists (DDS or DMD): Dentists are your primary oral health care provider. Dentists diagnose and treat dental issues, perform procedures like fillings, crowns, and extractions, and help you manage your overall oral health.
• Dental hygienists: Dental hygienists specialize in preventive care. They clean your teeth, apply fluoride treatments, take X-rays, and provide education on proper brushing and flossing techniques.
• Dental assistants: Dental assistants help dentists during procedures, manage tools and equipment, take X-rays, and support patients throughout their visit.
• Dental specialists: These are providers with advanced training in specific areas of oral health, including:
  • Orthodontists: Focus on straightening teeth and correcting bite issues with braces or aligners.
  • Periodontists: Specialize in diagnosing and treating gum disease and dental implants.
  • Endodontists: Specialize in root canal treatments.
  • Oral surgeons: Perform surgical procedures such as dental implants, corrective jaw surgery, facial trauma repair, cosmetic facial enhancements, and more.

Check out the full list of recognized dental specialties from the American Dental Association.

Dentists, dental hygienists, and/or dental assistants will likely be the dental care providers you see most often. However, all dental care providers, including specialists, are here to assist you when you need it.

What is dental insurance?

Dental insurance is a type of health benefit designed to help you manage the cost of dental care. It typically covers a portion, or in some cases the full amount, of preventive, basic, and major dental services, making it easier and more affordable to maintain your oral health.

Dental insurance may be offered through an employer, purchased individually, or available through certain government programs. Plans often include features like annual maximums, deductibles, copayments, and provider networks, so it’s important to understand your specific coverage.

While it may not cover every expense, dental insurance plays a valuable role in promoting routine care, such as seeing the dentist regularly, and helping manage unexpected dental costs.

What is the difference between dental care providers and dental insurance?

While dental care providers and dental insurance often work hand-in-hand, it’s important to understand that they serve different roles. Simply put, dental care providers deliver the treatments and procedures, while dental insurance helps cover the cost of that care.

Who to contact: Dental care provider or dental insurance company?

It’s not always easy to know who to contact when you have a question about your dental care.

Here are some common questions, along with guidance on whether to reach out to your dental care provider or your dental insurance company, so you always know who to contact.

Question: How much will this procedure cost me?
Contact: Dental insurance provider
While your dentist can give you a general estimate, only your insurance provider can confirm your specific coverage, including deductibles, copays, and what’s covered under your plan. If you really want to know how much something will cost, get a pre-treatment estimate.

Question: Do I need pre-authorization for this treatment?
Contact: Dental insurance provider
Some procedures require prior approval before they’re covered. Your dentist’s office may help submit the paperwork, but the insurance company makes the decision.

Question: What happens during this procedure?
Contact: Dental care provider
Your dentist or specialist will be the one to explain the details of any recommended treatment, including what to expect during and after the procedure.

Question: Why didn’t my insurance cover this?
Contact: Dental insurance provider
If a claim is denied or only partially covered, your insurance company can explain the reason. In some cases, you may need to contact your dental care provider for additional documents. You may be able to appeal a denied claim. Work with your dental insurance provider directly for that.

Question: Can I reschedule my appointment?
Contact: Dental care provider
Scheduling, rescheduling, or canceling appointments is handled directly through your dental office.

Question: What dentists are in my network?
Contact: Dental insurance provider
Your dental insurance provider will have a list of in-network providers to help you avoid unexpected out-of-pocket costs. Delta Dental of Wisconsin makes it simple for members to find in-network providers with our online search tool.

A good rule of thumb is to reach out to your dental care provider for questions about treatment, appointments, or any dental emergencies. For plan details, coverage questions, or claim issues, your dental insurance company is the best resource. If you’re part of a group/employer-sponsored plan, you could check with your HR department too!

Save yourself time and frustration by contacting the right person first

We understand that when you have a question about your dental care, it can be frustrating to be bounced around from person to person. Save yourself the time and stress by getting to the correct place first.