The Facts About Dental Insurance

I’ve personally worked with most of the major dental insurance companies over my career. I’ve been an in network provider for many as well as being an out of network provider for others. In this time, I’ve come to really dislike these companies for many different reasons, the primary being that they interfere with your dentist’s ability to provide optimal care for you.  Here are the real facts about dental “insurance”

• The main reason why dental insurance is so terrible, is because it isn’t really insurance at all. The point of most insurances is to protect you from a catastrophic event that would financially destroy you otherwise. In dentistry this is actually a pretty rare scenario. Most people need consistent dental care, and in those cases where you do need significant work, your insurance isn’t going to cover it. Think about dental insurance more as a discount plan than anything else.
• Dental insurance reimbursement for an in network dentist is somewhere between one half to three quarters of their actual fee. On average an in network dentist is going to have to use less expensive materials, use cheaper dental labs, and spend less time with each individual patient. This isn’t always the case but oftentimes is.
• Dental insurance maximums haven’t changed significantly for 30 years while premiums have continued to increase. Most plans max out at paying $1000-1500 per year. While this was great in 1980, at today’s prices, if a single teeth needs a root canal and crown, you’ve maxed out your plan.
• Dental insurance companies exist for one reason, to make money, and they do this very well. They don’t care about you and all their policies exist to limit expenses. Many top executives in these companies make over a million dollars a year.
• Dental insurance companies actively work to decrease usage of dental services. They most commonly do this through waiting periods on major work (which most people don’t know is in their plan until it is too late) and making providers do pre-determinations (which aren’t binding anyway). Neither of these things are in the best interest of your oral health.
• Dental insurance companies have arbitrary limits on what is covered and how often. These limits aren’t necessarily based on evidence of what is best for you.
• They deny payment for treatment on a consistent basis, even when there is clear evidence of it’s necessity. One of my most recent cases was on a patient who had a root canal on a back molar. The standard of care in dentistry is that these teeth need a build-up and crown as soon as possible after the root canal in order to prevent the tooth from breaking. Despite us sending in x-rays, pictures, and a description of what we did, they still denied the build-up saying it wasn’t necessary! These costs are directly passed on to patients.
• They ask for money back after paying. I had a patient who had oral cancer who needed a denture made. We received written authorization to go ahead with the denture which we made for the patient. 6 months later, they sent us a letter asking for the money back because they said they made an error in payment!

If you’ve got dental insurance, keep all this in mind. If your dentist recommends something outside of what your plan covers, there may be a good reason for it. Ask him or her about it and in most cases they’ll be happy to discuss why they are recommending it.