What Exactly is Dental Insurance?

Dental insurance…those two words usually have a negative connotation for everyone that has to deal with it. From patients to providers, no one really ever has a good experience when it comes to dental insurance. But what is dental insurance really?

Delta Dental offered their first dental insurance plan in 1972. That plan that they offered had a $1000 yearly maximum. A thousand dollars bought a lot of dentistry back in 1972. If most of you look through your dental benefit booklets today in 2015, most of you will see that your yearly maximum is…$1000.

How is that possible? Let me paint a picture of what 1972 looked like. On average, the cost of a new house was $27,550, the average income was $11,800, a new car cost $3,853, and the yearly maximum for Delta Dental was $1000.

If you look at what the averages are 40 years later, it becomes pretty alarming. The average cost of a new house today is approximately $277,400, the average income approximately $40,560, the cost of a car approximately $32,600, and the maximum for dental insurance through Delta Dental, or any other insurance company really, on average is $1000.

We can’t look at dental insurance anymore the way we have for the past 40 years, simply because it is not the same. The cost of doing dentistry has gone up exponentially as everything else has, but the dental insurance maximum has stayed the same.

We have to shift our thinking to think of dental insurance for what it really is. It is a predetermined benefit that allows for a reduction in fees (if within a PPO network), and a specified amount, usually just $1000, to help cover the cost of dental treatment. Dental insurance isn’t based on needs or diagnoses, nor do they change benefits for individuals based on any criteria. A healthy twelve year old that has never had a cavity gets the same thousand dollars to use a year as a sixty year old with heart disease and diabetes linked to the periodontal disease that they have present in their mouth.

Dental insurance companies have reduced dental insurance to basically a health savings account for dentistry. They give you a thousand dollars a year to use for dental treatment. If you need to just come in for your biannual preventative maintenance visits, you use approximately $300 of that thousand, and they keep the other $700, in addition to the premiums either you or your employer pay, because dental benefits do not typically rollover year to year. You cannot save them for when an emergency arises. Say an emergency does arise and you break a tooth eating popcorn while watching a movie. Your insurance company doesn’t care how or why you broke your tooth, you still just have that thousand dollars to help you cover the cost of what you need.

Insurance companies have effectively changed the mindset of everyone over these last 40 years, making everyone adhere to get their dentistry done the way that the insurance companies want them to, a little at a time. If you need a root canal on one tooth, and have cavities on 3 other teeth at the same time, the insurance company has instilled in our brains that because the root canal will generally use up that $1000 worth of coverage that they provide, then the other 3 cavities have to wait until the following year to be done because you will be maxed out of insurance.

What they don’t tell you is that while you are waiting that year to go by to get the other cavities done, the decay is eating away at the healthy parts of the tooth, and by waiting a year, there is a chance that you could need 3 root canals by the time that the insurance has rolled over and is ready to help pay for the fillings that you needed at least 12 months ago.

What are you going to do in that scenario? Get one root canal done, wait another year in excruciating pain to get the next one done, and two years for the third? All the time blaming the dentist that their fees are too high because the fees for dentistry (which the insurance companies set, by the way) have risen with the times just like everything else has…except for dental coverage.

I am not by any means saying that dental insurance doesn’t help patients pay for the treatment that they need, they most certainly do. What I don’t understand is how we got to a place where we let insurance companies dictate what dentistry we have done and when, when they don’t know, or care, what condition our mouths and our bodies are in, and everyone seems to be okay with it.

3 thoughts on “What Exactly is Dental Insurance?

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