The Deception of Dental Insurance
About once a day, a patient declares: “I can’t get my teeth fixed because I don’t have dental insurance.” Many patients do not understand how dental insurance works. It is not fair to blame the patients for being confused about what benefits are offered. The general information that the insurance companies provide is vague and there is much it does not explain. Though it would be impossible to convey every coverage detail here, so-called dental insurance is not what most expect.
In the mid-70’s, when dental insurance was just coming onto the scene, the benefits were about $1000-$1500. Of course, the premiums that were paid to insurance companies have steadily increased over the last 35 years. Additionally, today $1000 does not buy nearly the same amount of dentistry that it bought in 1975. Back then, a crown fee was $222. Now it is about $1200. The coverage has not kept pace.
The purpose of any insurance is to protect you from catastrophic loss. You buy home insurance in case your house burns down. You buy medical insurance in case you have to be hospitalized. Do you need insurance to pay a $1500 dental bill? The insurance generally only covers 50-80%. This so-called insurance is of more benefit to the insurance company than it is to you!
Most seriously, this kind of “insurance” distorts your perception of dentist’s recommendation. It complicates your treatment plan because there is now a third party advising you on what dental care you can receive.
Consider a common situation: a patient needs to be re-evaluated for periodontal disease in three months, but the insurance company will only pay if seen in six months. The adjusters have pre-set rules for every condition, regardless of personal situation. But no two patients have the same conditions! Nonetheless, those unfamiliar with patient needs are determining what the patient receives. Sometimes such a patient will forgo the needed appointment because the insurance company refuses to pay for it.
Another example: you need a crown and the insurance determines they will only pay for an amalgam. This confuses you because you may think we are recommending unnecessary work. But the insurance examiner has never seen you, and yet they dictate your treatment. Please remember: the insurance companies are not interested in your dental health. They are only interested in charging you as much as possible, and paying out as little as possible. They profit most when they deny as many procedures as possible.
In contrast, our goal is to protect your teeth, and keep you out of dental trouble.
Dental coverage may be a benefit provided by your employer and you do not have to pay the premiums yourself. Whatever your employer pays does help with the treatment fee. If you pay individually, evaluate how much it will cost you versus what they are willing to pay. Quite often the “benefit” is not worth the cost.
If you are an employer, proceed with caution. Providing dental insurance as a “benefit” may not be as valuable as other ways to aid employees. More dangerously, buying into this system does help to perpetuate it. There could be other benefits that are more helpful.
It is the responsibility of the insurance company to make coverage policies clear to patients. But it is in their economic interest misrepresent and keep vague. So to understand the benefits of your policy falls into your hands. And, unfortunately, we have only limited ability to help you understand policy. Rather, we can help you make the best choices for your health and circumstances.
Dental insurance should not determine getting the care you need. Such a decision belongs with you, supported by our care, skill, and judgment. —Arnold K. Chernoff, DDS, http://www.chernoffdds.com/