Dental Insurance Facts

We work with all PPOs.

The History of Dental Insurance

Dental “insurance”* had its beginning in the early 1960′s. It appeared that indemnity “insurance” would encourage those patients who needed or wanted dental treatment to have these services performed. Some dentists began to warn those in leadership positions within our profession of the possible perils to quality that might occur if dental “insurance” companies, with no dental training and no dental license, began to determine diagnosis, treatment and fees for a particular service. In retrospect, these warnings were lightly heeded by many dentists. Could the “insurance” industry actually exert that much control over the dental profession? (For the answer, you might take a peek at the medical profession today)

Dental Insurance As It Is Now

Like so many encroachments we experience in life, the “insurance” industry was not satisfied with its influence on treatment plans and fee determinations. Eventually, a larger piece of the pie was requested by the industry in the form of “managed” care. This is where dentists who enlist, agree to reduce their fees by as much as 20% in order to have patients placed in their chairs. Managed cost, NOT managed care. Current American Dental Association data shows that the average dental office overhead is well over 70%. What type of care can those offices deliver given this arrangement? Where will that office cut its quality in order to cover the high cost of being a member dentist on these plans? It’s definitely lose/lose/win for patient/ dentist/ “insurance” company.

There are three primary reasons for the infiltration of managed care into dentistry:

  • Profit potential for “insurance” companies.
  • Oversupply of dentists
  • A generation of people who have been conditioned to believe that all health-care coverage is a “right”.

Our Relationship with Dental Insurance

Our practice was required to make a decision a number of years ago as to whether we would become an “insurance-dependent” practice. What precipitated the need for this decision process?

  • The mounting “ill will” we were experiencing resulting from being caught in the middle between the “insurance” company and the patient. We offer only high-quality care and that was being denied due to the companies’ “LEAT” (least expensive alternative treatment) policies.
  • Countering the inflammatory information that was sent to the patient, stating that our fees were higher than usual and customary. All our colleagues have experienced this – you cannot find a dental office whose patients have not received this type of letter from their insurance company. Since “insurance” benefit maximums have not changed within the past 25 years (but premiums have certainly increased), their profit level is dependent upon the dentists not adjusting their fees according to normal inflationary processes, and most often there are exclusions in the contract that require this, no matter how the operating costs change.
  • The fact that “insurance” companies typically reimburse the patient more quickly than they do the dentist.
  • “Insurance” companies change mailing addresses and phone numbers often, and we were not provided updated information. In other words, it is actually part of their strategy to keep making themselves hard to reach, allowing them to delay paying claims.  The flip side of the coin is that employers change “insurance” companies often, and again, the dentist (and sometimes the patient) is not notified of the change. In many insurance dependent offices, you will find at least one full time employee dedicated to the engendered “red tape”. Think for a moment: this person works for the insurance company, but is hired and paid for by the dental or medical office.
  • Many patients develop expectations that shift their responsibility to the dental office to find out about their benefits (annual maximum, remaining benefits, deductible amounts, etc.)

Our primary objective is to provide dental excellence at a fair fee; the “insurance” company’s primary objective is to earn a profit for its shareholders. We will gladly assist our patients in obtaining their full benefits, but we will not allow “insurance” companies to dictate the standard and quality of our care.

* The word insurance is defined as “protection against a loss”. The term has been used in medicine, as catastrophic loss can occur as a result of sickness or accident. This term has been used in dentistry, but it is actually a misnomer. “Benefit” more aptly describes the allowance that is negotiated for an employee between his/her place of employment and the “insurance” company. All dental “insurance” companies have a table of benefit allowances which very rarely exceeds $1500 per calendar year and adds many exclusions or “non-covered” services. This allowance amount, by the way, is almost exactly the same as the benefits of the 1970′s.

**If dental benefits were to have kept up with inflation such as the cost of dental insurance premiums has, today’s average allowance would amount to over $10,000 per year. NO dental insurance provider even closely approaches that amount of benefit for its members.

For more information, please read Dr. Jim King’s article “The Dental Insurance Industry And The Dentist.”