My team and I get a lot of questions about dental insurance: “Why isn’t your practice in my plan? Why didn’t my dental insurance cover this? Why can’t I just have treated what my insurance covers?”
I’d like to shed some light on this issue. Let’s look at what insurance really is, share a little history, describe what it looks like today and where it may be in the future, and expose the true relationship (or lack of) between long term dental health and dental insurance
Insurance is intended to protect us from catastrophic loss. If your home is destroyed, homeowners insurance may allow you to rebuild. Medical insurance will pay for an emergency appendectomy or a heart bypass. The risk of buying insurance is determined by you proving detailed information about what is being insured. You determine your risk, that risk is calculated and a premium is charged
On the other hand, dental “insurance” does not inquire about your current state of health but provides a “one size fits all”approach to coverage. You are not asked about your dental history or current state of health. Yearly benefit limits in dental insurance have no relationship to the condition of your mouth but exist only to limit costs to the employer or provider of the insurance. As a result, dental insurance is not really insurance, but simply pre-paid specific benefit that has no relationship to your own state of dental health or disease. It is good to have some benefit, but that doesn’t make it insurance.
History of Dental Insurance
The nature of dental “insurance” has changedconsiderably since it was introduced by General Motors in 1971 to make employment in their plants more attractive. Back then, there was no limitation on which services were covered: the fee for a crown was $175 and the maximum was $1000 for total treatment per year. By 1990, the fee for a crown was $500 but the year maximum was still $1000. By the year 2000, a crown fee was $800 and yearly maximum was still $1000; today the yearly maximum is still $1000 and the crown fee is over $1400. The clear trend in dental “insurance” is to control costs by limiting the yearly benefits in addition to shrinking the scope of the procedures covered. Think of dental insurance as a gift card you can use toward your care, but this gift card has shrunk over the years.
Dental Insurance Today
PPO stands for preferred provider organization, one form of dental insurance. Dentists who participate in these plans agree to accept a lower fee for these groups of patients, somewhere between 30 – 40% lower than their normal fee. The trend of participation by dentists is up.
There are three consequences to this trend for you as a dental patient. First, to make up for the lost revenue by accepting the PPO plan and cover the typical 70-80% overhead of operating a dental practice, dental offices must increase the volume or number of patients being treated and speed up the pace of care for each patient. This means less time discussing what you want for your dental health; less time learning about how to prevent disease for the rest of your life. Secondly, patients in these plans may find limited access to dental care because the fees collected for these plans are significantly less than patients who pay normal fees. This can mean long wait times for appointments or emergencies. Lastly, patients in a PPO plan pay one fee and everyone else in the practice pays a different fee. With only about 50% of Americans having any dental insurance at all, we don’t believe it is fair that people without dental insurance pay a higher fee than others in a plan.
While we are not preferred providers in any dental insurance plan, you can still use your benefit in our practice. We do not participate in the “plans” because we believe the way to treat you with respect and dignity means that we must take the time to understand your goals, your expectations, your circumstances, and your problems. We must take the time to learn the cause of your dental issues so that they can be eliminated. We must take the time to teach you what is going on in your mouth, so that you can be active in developing and choosing a long term plan for dental healththat fits into your life. It is not possible to take this much time in a high-volume, fast-paced, plan participtating dental office, and we don’t believe that is the right way to care for people! We don’t treat a high volume of people or provide treatment at a fast pace because this is dehumanizing – treating people like parts on an assembly line.
Long Term Dental Health vs. Dental Insurance
What is the relationship between ling-term dental health and dental insurance? If you rely on dental “insurance” to get or keep you healthy, you will be disappointed to experience problems in your future that simply cannot be addressed by dental insurance alone. Dental decay, gum disease and “bad bites” are why people lose their teeth. Dental benefits may greatly limit the effective treatment of these basic problems.
You can eliminate your need for dental insurance by finding a dental office that takes the time to help you be healthy rather than just race you through a system that attempts to fix disease. You can learn how to take charge of your dental health and not spend the rest of your life “fixing” your teeth. That is what you will find in our practice.