The Dental Insurance Industry and The Dentist

Article by Dr. Jim King

Dentistry is far more than just a job or a business for us at King Dental Group. It is not only our life’s work, but more importantly it is also our passion. Throughout our many years of a dental career we have always pursued the highest level of preventive and treatment excellence to offer you, our patients. The following will spell out how a third party like dental insurance can intrude into a relationship and stand in the way of the excellence that we routinely provide for you.

When a person with dental insurance benefits is given a list of enrolled dentists, you know there is a contractual relationship that exists between the dentist and the insurance company. The fundamental reason that the dentist signs with them is the simple fact that the dentist is then promised a pipeline of new patients in exchange for abiding with the conditions of the contract. Some of these conditions limit the type of treatment that the dentist can render, and they most often regulate the dentist’s fees, which actually vary from zip code to zip code. It is important for you to know that when a dentist signs on to be a provider for an insurance company, he or she has to make a number of compromises. We decided a long time ago that we couldn’t make those compromises and still maintain our commitment to quality care.

The reason for this decision was that dentists such as those of us in King Dental Group who have continued their education (well beyond the usual and customary), would be restricted in performing many procedures that are “outside the scope” of the insurance company’s benefit limitations. Treatment that we know is best for a particular situation is very often either disallowed or has few benefits towards it. In their own language, the dental insurance industry defines these limitations to be “usual and customary” procedures. Quite frankly, when just out of dental school most of the dental problems are in fact very similar and their solutions might well fall within a usual and customary range of treatments. Now, with many thousands of hours of continuing education, we see things much differently and find that excellence requires more advanced, modern and custom treatment methods. Also, although they speak quite differently, it takes very little to realize that insurance companies have no real interest in the health of you the patient — as evidenced by denial of benefits for some of the most important basic preventive and treatment services, and limitations on many other procedures, (to say nothing of delayed payments).

Why would there be payment delays, you might ask? I have spoken to former claims people in the dental insurance industry and it’s really quite simple. Insurance IS a business, and they stay in business by making a profit. So, each day they know their income (it’s called “premiums”. The uncertain part is the outgo (known as “claims”.) If you were a claims adjuster, you would know at the beginning of the day how much you can approve in payments for that day. If you “spend” all your daily allowance, then it becomes your next duty to “creatively” delay payment on whatever else is in your pile that day. You can “lose” the claim, return it with questions, claim that all paperwork was not complete . . . there are a myriad of ways to accomplish your “duty”. We advise our patients of this very common tactic, and have been able to help many to demand more speedy service.

I treat all my patients the way I would treat my family. The cost of delivering this level of care is extremely high. The greater percentage of every dollar you spend with The King Dental Group goes right back into maintaining this level of excellence — from the laboratory that fabricates the dental restorations, incredibly well trained staff, the latest high-tech equipment, to the finest continuing education courses available in the world today. Insurance company fee schedules force the highly skilled dentist to make compromises in these areas and we will never compromise your treatment, in any manner.

Dentists make many choices of which the public is never aware. These are critical decisions that have a great deal to do with the quality of dental care you receive. For example — consider the degree of quality in laboratory fabrications. Sure, if it’s a cosmetic treatment, you might be able to see differences in quality. But most differences are subtle– issues of fit (at the micron level), quality of materials (indistinguishable to the eye), and of the workmanship itself – and these could be no issue until sometime later. This level of quality can cost a highly-trained dentist many times more than a “usual” dental laboratory.

It is very interesting to note that since dental insurance came on the scene in the early 70’s, the yearly maximum benefit allowance hasn’t changed a bit. It was $1,000 – $1,500 per year then as it is the same today, and yet insurance premiums have consistently been increased. The benefits to you, the patient, have not even begun to keep up with the cost of living. (See Dental Insurance Misnomer)

Although this practice has no formal or contractual association with any insurance companies, many plans do allow a patient to see a dentist of their choice outside of their plan. If you do have dental insurance, you cannot match the service you would receive from our team and our doctors in assisting you to obtain your optimum benefits from the plan.