Why isn’t your office on the insurance Preferred Provider list?
An HMO/DMO/PPO insurance company sets a cap on fees that can be charged for procedures. By joining a HMO/DMO/PPO group, the dentist agrees to abide by these restrictions, which enables the company and the patient to know the predetermined costs. Because fees are controlled, it is possible that a participating dentist may need to control your treatment options, the materials used and the time that can be spent with you during treatment, none of which can be construed as beneficial to you, the patient. Our office believes your dental health is too important to allow any third party insurer determine how your teeth should be cleaned or restored!
Why does my insurance only provide $1000 of coverage a year?
In the mid 1960’s increased competition forced the insurance companies to start offering other services in addition to medical insurance. Many companies started offering $1000 worth of annual dental insurance to sweetin’ the pot so to speak. Over the past forty years we have seen some plans increase their coverage to $1500 or $2000, but a majority still only provide $1000 of annual coverage. If these plans had kept up with the rate of inflation they should be offering $6000 worth of coverage. Why the insurance companies haven’t increased the annual benefit is anyone’s guess. It is safe to assume that your dental health is not one of those reasons.
How does dental insurance differ from other types of insurance?
Dental insurance really isn’t insurance at all. It is really just a benefit. When you purchase a car you call your auto insurance carrier and are given a quote based on the type of vehicle you have purchased. Any time you submit a claim to your car insurance the premium is adjusted higher. If you get a speeding ticket, or are in a car accident the amount you pay goes up. If you use your auto insurance too much, the insurance company will stop coverage all together! With dental insurance, everybody has the same type of car. When you signed up for dental insurance, did they inquire about your current dental health or past dental history? A healthy mouth pays the same as an unhealthy mouth that may require extensive treatment. Each year you are allowed to up to $1000(or whatever limit your policy states) every year. This amount does not roll over into the next year. If you use all of it or none of it your premium stays the same. Auto, Health, Life, and Disability insurance are necessary for catastrophic events that could lead to financial ruin. Fortunately, there aren’t too many catastropic events that can happen to your mouth. Routine hygiene visits and check ups can usually catch problems before they become catastrophes. Dental insurance is a benefit that provides $1000-$2000 towards dental care. Which means that dental insurance is the only type of insurance that doesn’t provide coverage for major dental events, it is better used towards routine dental care. Think of dental insurance as a dental coupon, in which you can use toward care.
My insurance policy states that they pay 50% for major coverage. Why isn’t that 50% of your office’s fee?
The insurance companies use a term “Usual, Customary, and Reasonable” or “UCR”. We really don’t know how they come up with fees, but one thing is for sure they don’t adjust these fees for rates of inflation or new technology. There are some insurance companies that haven’t adjusted their fees in many years, which explains why they haven’t raised their annual benefit in 40 years either. Our fees reflect the time, technology and experience necessary to provide quality dental care in the 21st century. Unfortunately we are unable to provide high level dental care at fees determined by a third party.
My employer is dropping dental insurance coverage, should i purchase private dental coverage?
Some companies still offer dental insurance coverage, but will defer the cost to the employee. This can be very expensive, some plans can cost $400-$600 annually. Some companies are dropping coverage all together. Since most dental coverage plans offer $1000-$2000 of annual dental benefit as we discussed before it doesn’t make much sense to pay $600 for $1000 worth dental benefit. For most people in this situation it is far better to pay themselves the $600 and self fund their own dental insurance. $600 would be more than enough to cover routine hygiene visits, xray and exams annually. If any other work is necessary, such as a few fillings or a crown, our office has some flexible financing plans that are very reasonable. The Optimal Dental Health Program may be worth taking a look at if your employer is considering dropping coverage.