Dental insurance plays a big role in how people obtain dental treatment. I strongly feel my patients deserve the best possible care. In an effort to maintain that high quality of care, I want to share a few truths about your dental insurance.
TRUTH #1: Dental insurance has never been, and never will be, a pay-all service.
The insurance that you buy, or the policy your workplace provides, is only there to assist you in the payment of your preventative and basic dental needs. This means many routine dental treatments and services are not actually a covered benefit or expense, and may be completely excluded by your policy. Many times, the treatments that I deem necessary for your dental health and overall well-being are deemed “unnecessary” by insurance providers. Remember…I am obligated, and took an oath, to provide you with the very best dental care that I possibly can. Insurance limitations will not dictate how I recommend and provide you with excellent care. Who would you rather have looking out for you and deciding what is necessary for your oral healthcare…your insurance company or your dentist? I personally will not let insurance companies and their coverage dictate my treatment plans and judgement of what I have been trained to deem necessary for your well being.
TRUTH #2 Insurance companies have a “usual and customary” fee schedule, but it may or may not be accurate in relation to what “usual and customary” fees are for North Liberty or even Iowa.
Time and time again I have seen insurance companies tell their insured customers that “fees are above the usual and customary fees.” Could it actually be that their benefits and coverages are too low? Obviously, it is much easier for an insurance provider to tell the insured customer the fees of the dentists in the community are above the usual customary fee rather than admit their benefits and coverages are too low. There are many ways insurance companies can calculate usual and customary fees, therefore it is possible that different insurance companies will have different usual and customary fees even in the same localized geographical area.
Most insurance companies run on a calendar year. Any premiums paid this year expire on December 31st and you are never able to go back and claim benefits that were paid but unused (depending on your particular insurance, some may run a calendar year beginning and ending in a month other than January). Therefore, in the dental insurance world it is a use it or lose it way of life.
TRUTH #3 Insurance is really a contract between you and your employer.
The benefits you receive are determined by how much your employer pays for the plan, what plan they have chosen to provide, etc. The less they pay for the insurance, the less you will receive. Many plans state a certain benefit will be covered “up to 50%, 80%, or 100%.” This is where things can get sticky…even though that is what we are told many times this may not be the case. Many insurance plans pay less than that 50%, 80%, or 100% depending on their established fee schedule. And remember, their fee schedule rarely aligns with those of dentists throughout your community and/or state.
TRUTH #4 Insurance companies, like many other businesses, exist to make a profit.
There is no harm in that whatsoever. But their obligations should be to their consumers, i.e. those they insure. This is not always the case. The ways they cut costs, in many cases with consent from the employer, are as follows:
1. Recommend, and/or only cover, alternative “cheaper” treatments (such as silver fillings vs white fillings)
2. Limit certain services on a yearly basis (such as fluoride 1x/year vs 2x/year, only allow two exams/year no matter what emergency issues may arise)
3. Provide and/or lower certain amounts of coverage (80%, 50%, etc)
4. Completely exclude the benefit from your plan (often they completely exclude coverage for the best treatments available, such as dental implants to replace a missing tooth)
A quick history lesson…
Dental treatments and cleanings used to be on a fee-for-service basis until 1954, when the state of California introduced the first dental insurance plan. This, rightfully so, became popular and more widespread through the 1960s. Soon after, the concept of pre-payment came along via what was then called Delta Dental Plans. These plans, which gained popularity throughout the 1970s, had an annual maximum benefit/coverage of $1000…sound familiar? As you can imagine, dental fillings, crowns, etc. cost significantly less in the 1970s compared to 2018. But, your annual maximum has not gone up much at all even though your monthly premiums have more than kept up with the pace of inflation. Rarely some insurance policies nowadays may reach a $1500 maximum, but overall that is not much of an increase in comparison…$1000 then puts you at over $7000 today!
You may ask why dental treatment costs have increased so much since the 1970s, as you should. My response is simple, for the same reason the consumer price index has shown a steady increase over the years. It costs more to produce better, more scientifically advanced filling materials for better long term results, better surface treatments for dental implants (yes, we can actually grow your own bone on dental implants), and more ergonomically suited dental chairs (aka plush!) to keep your back aligned and eliminate more run-ins with insurance companies!