With all of the changes dentistry has seen over the past 50+ years, you would think that dental insurance would be changing to keep up with the times, but, sadly, that is just not true. Little has changed, with the exception of how successful they have become in controlling the dental marketplace. I would estimate that 50% of our patients? have some form of dental insurance, yet few of them really understand what this really means for them, and the limitations most coverages include.

    A few of the facts:

    1. In the 1960s, the annual maximum payout per person on a dental plan was about $1,000. Today, almost 60 years later, for the vast majority of them, it is still only about $1,000. Pathetic, isn’t it? Sadly, this annual “maximum” is easily reached if you need any restorative procedures in addition to your routine cleaning and checkups. With the costs being higher now than they were when these plans were designed and these initial limits set, after they pay for 2 cleanings/year, x-rays and an exam, having even just a single crown can easily put you over your limit.
    2. In the average indemnity plan, patients only see about 65 cents in return for every dollar in premium paid. The rest goes to the insurance company’s cost of doing business, salaries, profits, etc.
    3. Insurance companies are in the business of making money, not providing dental care. Providing dental care is only incidental to why they exist!
    4. Insurance companies have HUGE profits. Their CEOs are among the top paid execs. How is that? Well, it’s simple, actually. That’s because the money coming IN is always more than the money going OUT.
    5. No dental insurance company has ever lost a nickel on a dental plan. There are so many limitations, deductibles, and co-pays built into their plans that they can’t lose money! They designed the plans in THEIR favor to ensure that they would profit. And the only way to do that, is to collect more from you than they pay out for you. It just makes sense.
    6. “Insurance” is intended to cover your expenses with catastrophic problems (i.e., Flooding, Hurricane damage, Fire damage, etc.). Most of us pay, for example, Homeowner’s insurance premiums every year for our entire lifetime and never actually receive a dime worth of benefits (that is, if we are lucky enough to NOT have these types of catastrophes!) There is NO comparable “catastrophic” downside in dentistry.
    7. Clearly, because the cost of providing dental care being so high, the main purpose of dental insurance is not to cover dire issues, like most people think, but more to help prevent them — by encouraging regular maintenance, which is the one good thing they ensure. This is why they do cover the “little things”: Cleanings, exams. It’s kind of like AAA for your mouth. They will cover the preventive cleanings, exams, and less expensive things like fillings, but then they’ll nickel and dime you to death overpaying for the types of procedures typically needed by adults, like crowns or implants. And then! Often, even then, they dictate what materials must be used, or put a flat dollar limit on what they’ll pay for it, increasing your out of pocket expense for the level of care you have available, versus what they will pay for. For example, many current plans do not cover porcelain crowns on teeth further back than your canines. (Yes, you read that right.) They’ll often only pay for metal crowns there. Because they are not “in the smile line”! So, they are dictating your treatment. Another common limitation, is that if you lose a tooth, and don’t want to file down two otherwise perfectly healthy teeth (in front of and behind the missing tooth) to replace it with a bridge, and instead you opt for the “standard in care” today (a dental implant and crown), they won’t pay for the implant or the abutment, but some plans may pay a small portion of the crown for it. Another common limitation: You have to be on the plan for a full year before they allow benefits for “major” treatment (crowns, implants, dentures, etc). So, they’re getting their money first, you can be sure of that.
    8. Unlike most medical insurance plans, (who will cover everything from MRI, Colonoscopies, and tons of various types of diagnostic tests almost without question) dental insurance does a relatively bad job of ensuring that adults get the dental care they need. The American Dental Association Health Policy Institute did a survey in which the results clearly showed that cost is THE TOP REASON adults give for not going to the dentist. What is interesting, though, is that this is true even among adults who DO HAVE private dental insurance! And comparing dental insurance to insurance for other types of health care services illustrates just how badly dental insurance performs in providing any real financial protection. Dental care consistently ranks number 1 in terms of health care services that people delay or avoid because of cost, as affirmed in multiple studies from multiple data sources. Even for health care services with benefit structures similar to those of dental care—for example, vision care—financial barriers are far less severe.

    Again. It’s all about collecting more from you than they pay out for you. It wouldn’t make sense to be in the dental insurance business if it were any other way!

    I could go on, but surely you get the point. The bottom line is, you shouldn’t be misled by thinking they have your best interest at heart. Nor should you rely on them or allow them to make your treatment diagnoses or treatment decisions for you. Hopefully, now, you understand a little more about just why.

    We would be happy to discuss any concerns you have regarding your dental insurance and will do everything possible to maximize any benefits you may have coming to you. Please ask us for details. We’re always here to help.