- Dental Health

Truth About Dental Insurance


I have been a Patient Coordinator in the dental field for over 22 years now and I can tell you that dental treatment has evolved dramatically over those 22 years.  New products, new equipment and new techniques are introduced all the time, affording the dental patient the best opportunity ever for long term dental health.  Do you know what HASN’T changed much over the past 22 years?  Dental insurance.  Do you know why?  Because, dental insurance is designed to keep insurance companies financially healthy – not to keep patients dentally healthy.

Twenty two years ago, most dental insurance programs provided patients an average benefit of $1000 per year for dental treatment.  Here we are 22 years later and what do most dental insurance programs offer per year?  $1000, of course.   The fact is that there is not one single product or service that hasn’t increased in cost over the years. Dental premiums certainly have.   So how could this same $1000 provide the same quality dental care it provided 22 years ago?   Obviously, it can’t.  But amazingly, patients still expect that they will receive quality dental care within the confines of what their dental insurance pays.

In addition to the yearly limit set by dental insurance companies, reimbursement is also limited through use of specific dental “codes”.  Every procedure that is on the dental insurance company’s “list” has a code associated with it.  When a new dental procedure is introduced into the field of dentistry, one would assume that it would be assigned a code and added to the list.  Unfortunately, this is not the case.  It can take in excess of 10 years for insurance company’s to code a new procedure and sometimes the new procedures never make the list at all!

Adding insult to injury, insurance companies dictate not only which procedures make the list, but also what percentage of the fee they reimburse on each procedure.  The goal of insurance companies is to pay as little as possible of the $1000 per patient, each year.  In other words, even though you GET $1000 per year, they certainly don’t want you to USE $1000 per year, and they make sure that you don’t.  Remember, the less they pay out, the more profitable they are.  

So the dental patient trustingly goes to the participating dental provider for care.  However, instead of providing treatment that may be more up-to-date, more conservative, more predictable, more comfortable or may even cost LESS, a participating practitioner, (because he has signed a contract with the insurance company), is more likely to plan treatment based on what is found on “the list”.   Participating providers may not even discuss (or perform) treatment options that are not on the list and patients often incorrectly assume, “if it isn’t on my insurance company’s list, then I must not need or want that treatment!”    

If only insurance companies would allow patients to spend the $1000 as they choose.  Dental providers could then offer patients ALL treatment options and patients could decide for themselves what level care they desire.  Unfortunately, this is not likely to happen, because patients would be much more likely to use their entire $1000 per year and the insurance companies would be much less profitable.   Bottom line, patients need to be aware of the limitations of their dental insurance’s list and they need to ask their provider about treatments options that may not be a part of that list.   Only then can they make a truly informed decision regarding their dental care.


Source by Dr. Mark Weingarden

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