It has been ingrained in our minds as a society that, to visit a dentist, even for preventative care, we need dental insurance to help with the cost. I don’t know how many times I have heard from a patient, “I don’t have dental insurance right now, so I can’t come in for my six month checkup.” Now I know that there is an ongoing perception that going to the dentist is expensive, but that is precisely what dental insurance companies want us to think. Why else would we buy dental insurance? It isn’t required by the government like medical insurance, or car insurance. It really isn’t even insurance at all. Let me explain what I mean.
Most insurance plans work a certain way, whether it be medical insurance, homeowner’s insurance, or car insurance. In most of these cases, after a deductible is satisfied the insurance company covers the remainder of the costs of the claim, whatever it was for. An inpatient hospital visit can run up into the hundreds of thousands of dollars, repairs to an automobile after an accident can easily jump up into the tens of thousands of dollars. The insurance companies pay out those claims everyday. But for dental insurance, the median yearly maximum they pay out is $1000.
The way dental insurance works is: no matter the level of coverage you need, you usually only get $1000 a year to use. It has been that way since the inception of dental insurance back in the early 1960’s. Oh yeah, and normally they only pay one hundred percent for the preventative and diagnostic procedures like exams, xrays and cleanings. The more expensive procedures get, the less the insurance company will pay. Most dental insurance companies are set up on a percentage level payment system. What this means is that for anything diagnostic or preventative, as I said above, they usually will pay out 100% of the cost for those procedures. If you need a small filling, a deep cleaning, or an extraction, the insurance companies will usually pay those at 80% of the cost, after the deductible has been satisfied. For the major procedures like crowns, bridges, dentures and dental implants, the more expensive procedures, the insurance companies usually only pay out 50% of the cost after the deductible has been satisfied.
So now we have established a couple of ways dental insurance companies have minimized the amount they actually have to pay out to a dentist. It doesn’t get any worse does it? Well, when you initially sign up with the insurance company, they will usually give you a pretty thick booklet filled with fine print. That booklet is full of what insurance companies refer to as exclusions and limitations. In layman’s terms, what it really is, is a booklet filled with ways that dental insurance executives have thought up to pay as little as possible for each dental claim that comes in to be processed.
An example of one of these exclusions, and really the most absurd one, in my opinion, is called an alternate benefit. What this means is say, for example, you need a tooth extracted and replaced. There are a few different ways to replace a tooth after it has been extracted, the longest lasting and best for the patient would be an implant. After an implant, the next best thing would be a bridge, and then the worst esthetically and functionally would be something removable like a partial. So naturally, most patients opt to do dental implants to replace missing teeth. But when we send in the claim for the implant, the insurance company will take that claim, and according to page 37 paragraph 6 line 10, or wherever it is in your benefit booklet, paid the alternate benefit of a partial. Because a partial is the least expensive, but still medically acceptable way, to replace a tooth. Almost every patient we have ever made a partial for hates it, never wears it, and eventually it will lead to bone loss around the extraction site because it isn’t being stimulated by chewing anything there, but that’s what the insurance company thinks is best for the patient because it is the least expensive option. It goes on and on from there ad nauseam.
So in actuality dental insurance is nothing like medical insurance. The best way that I have heard dental insurance described is to think of it like a health savings account that the dental insurance company has set up for you. You or your employer pay the monthly premiums to the insurance company, and the insurance company sets aside about $1000 for each member to use per year for whatever procedures they need to have done, no matter what state of dental health they are in, and if they don’t use the whole $1000, they take the remainder of what is left and keep it as a profit.
Come back next week when I will get into the alternatives to dental insurance and why I feel that everyone would be better off without dental insurance at all.