INSURANCE QUESTIONS

I had a reader e-mail me an insurance related question this past week. This is an answer to that question, as well as a couple of other insurance related questions we come across frequently.

Patients will sometimes balk at treatment not covered by their dental insurance. Dentists will often hear, “Just do what my insurance covers. I don’t want anything extra.” In fact, a recent ADA poll showed that a lack of dental insurance was the #1 reason most patients gave for not visiting a dentist. So, here are some frequent questions patients often ask about dental insurance.

Why doesn’t my insurance cover all of the costs for my dental treatment?

Dental insurance isn’t really insurance (defined as a payment to cover the cost of a loss) at all. It is a monetary benefit, typically provided by an employer, to help their employees pay for routine dental treatment. “Dental Insurance”, which started in the 1970’s, was designed to cover a portion of the total cost of care. It has not changed very much since then. This usually leaves the patient with the responsibility to take some ownership in their dental health.

But my plan says that my exams and other procedures are covered at 100%.

That 100 percent is usually what the insurance carrier allows as payment towards a procedure, not what your dentist may actually charge. Dentist’s fees are usually a reflection of the level and quality of care in a particular office. Some cost more, some cost less, depending on the costs of running their office, how they pay their staff, the materials they use, etc. An employer usually selects a plan with a list of payments that corresponds to its desired premium cost per month. Therefore, there usually will be a portion not covered by your benefit plan.

If I always have to pay out-of-pocket, what good is my insurance?

Even a benefit that does not cover a large portion of the cost of what you need pays something. Any amount that reduces your out-of-pocket expense helps.

Why is there an annual maximum on what my plan will pay?

Although most maximum amounts have not changed in 50 years, a maximum limit is your insurance carrier’s way of controlling payments. Dental plans are different from medical plans, in that dentistry is needed frequently. Medical emergencies are rare. It is your dentist’s responsibility to recommend what you need.

Consider this: A typical medical insurance plan today can cost over $2000 per month, and still leave you with a $3000 deductible. The average dental plan costs $600 per year.

If my insurance won’t pay for this treatment, why should I have it done?

It is a mistake to let your benefits be your sole consideration when you make decisions about dental treatment. People who have lost their teeth often say that they would pay any amount of money to get them back. Your smile, facial attractiveness, ability to chew and enjoy food, and general sense of well-being are dependent on your teeth.

Other than complaining to your dental insurance company, or your Employee Benefits Coordinator, your best defense is to budget for dental care, or ask your dental office if they have payment plans to spread payment out over time……and most of all, keep regular maintenance appointments. The BEST dentistry is NO dentistry.

If you have any other insurance related questions please e-mail them to me.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.