Have you ever left the dentist’s office wondering, “Why didn’t my insurance cover more of that?” You’re not alone. Many expect dental insurance to work like medical insurance, but it often pays only a fraction — sometimes as little as $37 for a cleaning or $20 for an exam.

At Tanglewood Dental Associates, we hear this question often. The truth is, dental insurance was never designed to cover everything. Over the years, reimbursements have shrunk, networks have tightened, and patients are left questioning the value of their benefits. Add confusing rules like “downgrades,” where insurance substitutes a lower-cost procedure, and it’s no wonder patients feel frustrated.

In this article, we’ll break down why insurance covers less than expected, why our practice chooses to remain out of network, and how that decision allows us to provide transparent, high-quality care without cutting corners. We’ll also share how you can still make the most of your benefits through PPO plans, HSAs, FSAs, and flexible payment options.

Let’s take a closer look at what’s really happening behind the scenes — and how you can feel confident about your care and coverage.

How Dental Insurance Really Works

When most people think about insurance, they picture medical coverage: big hospital bills dramatically reduced by an insurance payout. Dental insurance is different. Instead of covering everything after a deductible, it works more like a coupon — reducing costs a bit, but rarely covering the full amount.

Here’s why: when a dental office contracts with an insurance company, it agrees to accept lower fees in exchange for being “in-network.” That means if a crown costs $1,000, but the insurance plan allows only $500, the office has to “write off” the other $500. As Alice from our team explained, “You end up writing a lot of money off every year. The numbers just don’t add up.”

At Tanglewood Dental Associates, we’ve chosen not to sign those contracts. This allows us to maintain transparent pricing without hidden discounts that compromise care. Patients with PPO plans can still use their insurance here — coverage applies toward our fees rather than being restricted by insurance limits.

Pull Quote: “When you participate with insurance, you may charge $100, but only get paid $50.”

This sets the stage for the next big question: if you still have insurance, why doesn’t it seem to cover very much?

Why Insurance Covers Less Than You Expect

It’s no secret that insurance companies are paying less than ever — especially after COVID. Alice described receiving a reimbursement check for only “$37 for a cleaning and $20 for an exam.” That’s a fraction of the actual cost of providing care.

Why is this happening?

• Encouraging in-network use: By paying so little out of network, insurance companies steer patients toward their contracted providers.
• Downgrades: Even when a patient chooses a more advanced treatment, such as a porcelain inlay, insurance may “downgrade” it to a cheaper alternative (like a basic filling) and only pay for that.
• Coverage limits: Most plans include maximum annual benefits or lifetime caps, particularly for orthodontics, often leaving patients with significant out-of-pocket costs.

The result is frustration for patients who feel they’re not getting the value they pay for each month. But this isn’t a reflection of your dentist’s care — it’s a limitation of how dental insurance is structured.

Pull Quote: “They’re paying less and less. Honestly, it’s shocking.”

The bigger issue, though, isn’t just the shrinking checks. It’s how these systems can influence the quality of care patients receive.

Why Tanglewood Dental Associates Stays Out of Network

More than 20 years ago, TDA made a deliberate decision: step away from in-network contracts. Why? Because the constant write-offs made it impossible to provide the level of care our patients deserve.

When dentists are forced to absorb half their fees, they have two options: see more patients in less time, or find ways to add charges. That often leads to rushed visits, overdiagnosing, or unnecessary procedures. Alice noted, “A lot of offices that are in network charge out for everything. They look for things to charge out.”

By remaining out of network, we’ve chosen a different path. Our pricing is transparent. Our recommendations are based solely on what you need — nothing more, nothing less. That honesty is why so many patients who try in-network providers eventually return to us.

Pull Quote: “Many patients return to us because the quality isn’t always the best in-network.”

For us, it’s not about cutting corners. It’s about building trust and delivering dentistry that lasts.

What This Means for You as a Patient

If you have dental insurance, you can still use it at TDA — just in a slightly different way. Here’s how:

• PPO plans: These allow you to see any dentist you prefer. Your insurance will reimburse part of the cost, even if the office is out of network.
• Claims support: Our team files insurance claims for 98–99% of patients, so you don’t have to navigate the paperwork yourself.
• HSA and FSA accounts: These can cover medically necessary treatments like fillings, crowns, or orthodontics. They can’t be used for cosmetic services such as whitening or veneers.
• Flexible payment options: From in-house plans (half down, balance over six months) to outside financing like Cherry, we make it possible to move forward with the care you need without financial stress.

By combining these tools, many patients find their coverage stretches further than expected. And even when out-of-pocket costs are higher, they have peace of mind knowing they’re receiving honest diagnoses and treatment that puts their long-term health first.

Pull Quote: “Most of the time patients pay out of pocket — but they come here because they trust the quality of care.”

Conclusion

The frustration many people feel with dental insurance comes from a simple truth: it was never designed to cover everything. Dental plans often pay less than expected, shrink reimbursements over time, and use rules like downgrades and maximums that leave patients with gaps in coverage.

That doesn’t mean you’re out of options. Understanding how insurance works helps you make better decisions about your care. At Tanglewood Dental Associates, we’ve chosen to remain out of network so we can focus on honesty, transparency, and the kind of dentistry that puts your long-term health first. As Alice shared, many patients who try in-network offices eventually come back to us — not because it’s cheaper, but because they trust the quality and clarity of the care they receive.

If you have a PPO plan, HSA, or FSA, you can still put those benefits to work here. And for costs insurance won’t cover, our flexible payment plans and financing options give you the ability to move forward without unnecessary stress.

Your next step: ask questions, review your plan, and lean on our team to help you navigate what’s covered — and what isn’t. Insurance may not pay for everything, but with the right approach, you can still get the care you deserve — and the confidence that comes with a healthy, lasting smile.

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