Hardly a day goes by that Smile Sarasota doesn’t have a call from a prospective new patient asking if we ‘accept assignment’ for their dental insurance. We do not. We are a ‘fee-for-service’ practice – our patients pay at the time of service and we are glad to file claims with the insurance reimbursement going directly to our patients. Often, the patient will appoint anyway, but some do not. Those who do not will eventually find out that dental insurance is not all that helpful.
Many patients think their dental insurance is health insurance. Not unreasonable to assume, by the way, but completely wrong. Dental insurance is really just a discount plan on some basic procedures. Also, in many ways it is the opposite of health insurance coverage, because the more catastrophic your need in health care, the better your coverage. Not true at all with dental plans.
Your plan was chosen and designed by your employer to save you some money on your dental care, but it doesn’t relate at all to your personal dental needs. It’s our job to tell you what you need to keep all your teeth, and keep them healthy, and most of the time there will be a cost to you. But it’s probably one of the best investments you can make in your health and the quality of your life.
Forty years ago, dental insurance benefits averaged $1,000 per year, which was the equivalent of around $8,000 today. Here is the kicker; the average insurance plan is still close to $1,000. Here are the facts and fiction of what everyone calls “dental insurance.”
Fiction: You have a major medical problem, which includes surgery and hospitalization. You expect your insurance to take care of the major expenses after the deductible, and it does. You would think dental insurance works the same way, but it doesn’t. Just calling it insurance is complete and total fiction.
Fact: People who think they have dental insurance really only have limited and restricted benefits that are controlled by an insurance company. A dental benefit is more like a coupon. It is only worth what the insurance company says its worth. It has nothing to do with what the dentist charges.
Fiction: To believe these two statements are true “My dental insurance will pay for it,” or “My dental insurance will pay 80 percent” is, in fact, fiction. They will pay a small portion of some procedures, up to the yearly limit, which is usually $1500 or less, minus the deductible.
Fact: In 1972, $1,000 was a lot of money. That year, you could buy a brand new Buick for $3,000. Crown fees were around $250 and the insurance company paid well. Basically, a patient could get two or three crowns a year on old broken down, filled teeth and in a few years, their mouth was fixed. Plus, the patient could get two cleanings a year and not even max out their insurance. It was a great deal for patients and dentists. If benefits kept up with inflation and raised the benefit ceiling each and every year with today’s benefit close to $8,000, people would still have a good deal. As it is, today’s crown price for one tooth will basically wipe out a year’s benefit.
Fact: Today’s dentistry is nothing like it was 40 years ago. If patients had problems, the choices were to pull, fill or crown. Today’s dentistry serves the patients with some of the most advanced, pain-free techniques in medicine. These procedures are not even covered by the dental benefit contract, or the procedures cost more than the paltry yearly benefit. Back then, there was no such thing as Managed Care. Today’s insurance companies want you to choose a dentist based on cost and assume that all doctors are equally talented, knowledgeable, caring, ethical, available and personable – and that just isn’t true. The dentist making the deal with the insurance company may take a cut up to 30 to 50 percent. In order for them to stay in business, they have to see more people, do more procedures and cut costs in some manner. And even though it is a managed care system, dental benefits still acts as a coupon and not insurance.
Fiction: The dentist and dental team should understand a person’s dental benefit, what it will cover, pay, etc.
Fact: The contract is between the employer, employee and insurance company. The dentist has no role to play whatsoever; they are simply caught in the middle. Dentists, as a whole, are great people who love to help others. They try very hard to accommodate by hiring extra staff just to handle the paperwork, phone calls, etc., that insurance companies require.
Most important: Never let an impersonal insurance company dictate your dental care. They couldn’t care less about your health, comfort, peace of mind or appearance. Be happy you have that coupon for some dollars off, but never expect them to rebuild your burned-down house.
Credits: Fred Joyal and Dr. Mac Lee