Dental insurance can be complex and confusing in many instances. We expect that when we have dental insurance it will cover much of the cost of any necessary dental treatment just like medical insurance should cover necessary medical treatment. However, this is far from the truth. In fact, most dental insurance plans cover very little of the overall cost of dental treatment.
People think that their dental insurance policy will take care of major events like house or medical insurance will.
People who have “dental insurance” really only have minor dental benefits that are determined by their employer and an insurance company. A dental benefit is more like a coupon. It doesn’t pay for the entire product or service. It only pays a vague percentage and it has a maximum it will pay each year.
“Because I need this dental work, my dental insurance will pay for it!” or “My dental insurance will pay 80 percent of what I need to fix my dental problems!”
In 1972, most dental plans covered $1,000 to $1,500 per year, and most companies paid the premiums. At that time, crown fees were around $400 and insurance could, would and did pay for 80 percent. Basically, a patient could get three or four crowns a year to repair broken down, filled teeth and in a few years, their mouth didn’t need any more major work. Plus, the patient could get two cleanings a year and not even approach their insurance limits. That was a great deal for patients and dentists.
40 years later, most plans still have $1,000 to $1,500 annual limits, and many people are paying half or all of the premiums. Today’s crown prices have more than doubled so one or two crowns will basically wipe out a year’s benefit.
Consider the following comparison to car insurance:
In 1972, few cars cost more than $6,000. That’s what your auto insurance would pay if you totaled your car back then. If auto insurance stayed the same as dental insurance, they would only cover a bumper or fender repair in today’s car.
“I get two free cleanings a year”
The Big selling point for most dental insurance policies is that policyholders and their dependents will receive two free cleanings per year, but is that really the case? In short the answer is no, while many insurance companies reimburse for preventative and diagnostic services at 100%, the amounts covered by the insurance company depends on whether the dentist is in-network or out-of-network. If the dentist is in-network, or contracted with the insurance company, the amount paid for these services is based on a contracted amount that the insurance company has decided upon and the dentist has accepted. If the dentist is out-of-network the amount paid is based on the reasonable and customary amounts for the area and vary depending on the insurance carrier and the particular policy. Any differences between the dentist’s fees and what the insurance company pays is left to you.
There are also exclusions and limitations that apply to dental policies, for instance many insurance companies do not provide benefits for fluoride over the age of 14. Which means you are ultimately responsible for that charge.
Dental insurance is helpful, but it does not cover everything, and as the old saying goes “the best things in life are free” unfortunately that does not include dental cleanings.
“The dentist and dental team should know what a person’s dental benefit is and what it will cover and pay, and if the insurance company doesn’t pay, it’s their problem.
The dental insurance contract is between the employer and employee (the patient), and the insurance company. The dentist has no influence on what “should be covered”. The employer and insurance company negotiate these things ahead of time. The dentist is simply caught in the middle.
At Paul A. Griffin, DDS, PA, we love helping people. We try very hard to accommodate our patients and try as hard as possible to help people maximize their dental benefit but it is getting harder and harder to do. Ultimately, the financial responsibility for all dental treatment is the patient’s.
A Final Word about Dental Insurance
The insurance companies did not build all the skyscrapers in New York, Chicago, etc., because they lose money. They created the system so they can make a profit. The best approach if you do have insurance is to just think of it as a coupon and not something that is going to pay for major dental problems.
And finally, over and over we see patients who “only do what the insurance covers.” This approach ends badly. By letting the insurance dictate treatment instead of Dr. Griffin, the care that patients get is never ideal, and almost always ends up with the patient needing more dental treatment than otherwise would be.
If you have any questions about your insurance benefits please feel free to call us here at 972-242-2155. Or you can use the “Ask Dr. Griffin” link at the top of this page.