FAQ
Everything you every wanted to know about Dental Insurance.
Everything you every wanted to know about Dental Insurance.
Dental insurance in it's current form is a relatively new invention that's only been around about thirty or forty years. But dental insurance by definition isn't really insurance at all. Insurance is the pooling of money by a group of people to pay for a rare or catastrophic occurrence like a collision, fire, or maybe an illness like cancer or heart disease. Traditional insurance usually has a pretty high deductible payment since occurrences are statistically pretty rare and recovery costs are usually high. Problems with the mouth and teeth on the other hand are usually neither rare nor catastrophic. So that makes dental insurance not really insurance at all but instead a benefit plan that some employers get to help their employees defray somewhat the cost of dental care. When dental 'insurance' was first offered more than forty years ago it was pretty simple. For a set premium payment patients could go to any dentist they wanted to and receive a benefit towards their treatment. In order to keep premiums somewhat reasonable most plans had a $1000 dollar yearly maximum. Skip forward three and a half decades and most plans have the exact same yearly maximum but monthly premium payments have skyrocketed! (Adjusted for inflation that same $1000 maximum is worth less than $150 today....pretty pathetic.)
Recently insurance companies have been trying a lot of different ways to keep premium costs to employers from rising too fast while continuing to please their shareholders with profits. (I guess all those high premiums for the same yearly maximum wasn't profitable enough.) Their efforts have resulted in an alphabet soup of different plans each one with different rules, restrictions and limitations. These plans are commonly known as PPO's, HMO's, DMO's, DFO's, and capitation plans. This hodgepodge of plans are thought up and changed around so often that even our in office insurance specialist has trouble keeping up with all the details of these concoctions. Unfortunately the common denominator with all these plans is that they all in some way limit your access to modern state of the art dental care. The most common restriction, even though it's actually illegal in most states, is the "requirement" that you have to go to a "provider" (a dentist who signs a contract with the insurance company that requires him/her to accept a lesser fee and abide by the judgment of the company in company referring patients to their office) from a list supplied by your employer according your specific plan. Actually, the vast majority of plans let you go to the dentist of your choice (they don't advertise it and it's usually buried in all that little fine print) but your benefit may be reduced somewhat if you choose an office that's not on the list. And of course there's the yearly maximum which, remember, hasn't changed in 30+ years. Many plans also include clauses that limit benefits to certain materials or treatments that the insurance company (not you and your doctor) determines to be "adequate" treatment. This is the infamous L.E.A.T. clause or "Least Expensive Alternative Treatment". Most of the time an insurance clerk with little or no dental training will decide based on limited information and without seeing your mouth the absolute cheapest way to "adequately" treat your mouth and teeth. (Ever had an insurance company tell you that they'll only pay for part of a silver/mercury filling even if you don't want a silver/mercury filling?) Sometimes, when pressured, an insurance company will send the claim to a dental consultant. This person, usually a dentist who is paid by the insurance company will then use his judgment, according to insurance company guidelines to determine, again without seeing you or your mouth how to best treat your teeth. The bottom line is, where dental benefits were once based on your particular needs they're now based not on what you need but on certain contract terms negotiated between your employer and the insurance company.
So what does this mean when you come to our office? First of all, our office is not a contracted provider with any dental plans. We do this not to limit you in any way but instead to give you many more choices and a voice in your own dental care. Not being on a provider list allows us to diagnose what's best for you and not what's best for the insurance company. We strongly believe that what is best for you and your mouth should be based on what you and your doctor decide is best and not what an insurance company clerk thinks is "adequate". It's no secret to most of the guests in our office that their insurance company really couldn't care less about them and simply wants their premium payments every month.
In my practice I've NEVER had an insurance company call me to discuss a patient's treatment unless it was to try to minimize the treatment...and the treatment cost. Insurance companies have always placed saving benefit dollars far above making sure their subscribers receive quality care. By not entering into a contract with any insurance company you can be assured that we will be YOUR advocate (not an insurance company employee) and recommend the best possible treatment for you. But that doesn't mean we'll fight any less to help you get the maximum benefit for your premium dollar. We will assist you in completing and submitting any and all necessary paperwork including appeals to make sure you get your moneys worth. Our commitment to you is to provide the absolute best care we possibly can to ensure that your teeth and smile look great and feel good for a lifetime.
Special Thanks go to Dr. Brett Taylor of Sydney, Australia, for allowing us to use his expert explanation of dental insurance.
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