Let’s explore some common dental insurance myths in this dental blog post shall we.
Myth 22: “My dental insurance will pay for it all.”
Unlike medical insurance, dental insurance has an annual limit. It is a partial benefit plan. It’s designed to give you some coverage for what we call “maintenance dentistry.” It was never designed to be a pay-all, but people confuse it with medical insurance. It is not the same.
Dental insurance does help, but it was only designed for the simplest type of dentistry that there is. The big problem is the annual limit, which is typically around the $1,000 to $2,000 range these days. That annual limit hasn’t kept up with inflation. If it had, it would be closer to $5,000 or $6,000 a year or more.
Fully one third of the people who have dental insurance don’t use it, which is sad. Dental insurance can be a great aid to a lot of people, and it’s our job to help you get every last nickel coming to you from your dental insurance. Just don’t count on dental insurance to pay for everything. It doesn’t work that way.
Myth 23: “If my insurance doesn’t cover it, it must not be needed.”
No, this isn’t how it works. Dental insurance benefits are purchased by an employer from a dental insurance provider. And just because a particular service isn’t covered doesn’t mean it’s not therapeutically needed; it just means that the employer did not purchase it from the dental insurance benefit company, or that the dental insurance benefit company doesn’t offer it.
Often I hear a patient tell me, “My insurance said that your fee isn’t usual, customary and reasonable” – not a good thing to hear from your insurance agency, as it often drives a wedge between you and your dentist, and it shouldn’t be this way at all.
Of course, the dental insurance company point of view is, “We want X number of dollars from the employer for every employee that’s covered, and we want to pay the dental provider “X minus” so that we’re profitable.” Somewhere around 35% of every dental insurance dollar paid goes to the dental insurance provider.
Now, I have nothing against a dental insurance company making a profit; this is entirely normal. But I do have something against this quote, this statement that’s made far too often that, “Your fees aren’t usual, customary and reasonable.” How insurance companies derive their fees are varied. You’ll have one company that says the fee is X, another one says it’s Y, another one says it’s Z.
The reality is that on survey of the Academy of General Dentistry, a group of 25,000 plus dentists, 80% of those answering said that insurance companies said their fees weren’t usual, customary and reasonable! How is that possible?
Here’s something to keep in mind: The quality of care does make a difference. A dentist is a dentist is a dentist is not true.
Don’t be surprised if what your dentist wants to do for you doesn’t match the benefits the dental insurance company wants to pay. In fact, expect it.
For a dental insurance company, a dentist is a dentist is a dentist. While we all know it’s not true, that’s how they like to do it. They make everybody into a commodity. In reality, dentistry is a very highly refined personal service that makes a big difference in your life, and, of course, a profitable insurance company wants to lump everybody together. Such is life.
