But I Don’t Have Insurance
June 26, 2012
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 No. 1 reason most patients gave for not visiting a dentist. These are often the same people that pull into the office in a $40,000 car…..that they replace every 5-7 years. 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” is only designed to cover a portion of the total cost.
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 much 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 is something. Any amount that reduces your out-of-pocket expense helps. Dental insurance should be considered more of “discount” than it is insurance.
Why is there an annual maximum on what my plan will pay?
Although most maximum amounts have not changed in 30 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, regardless of whether you have “coverage” or not.
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. People who place value in their teeth can always find a way to afford treatment. Just like there are many different types and costs of cars available to consumers, there are similar options in dental care. Why not put some money into your teeth that will depreciate far less than that car…. and serve you much longer?
What Would You Do?
April 16, 2012
The ABC show, “What Would You Do?” with John Quinones, is a reality show using a hidden camera that puts ordinary people on the spot with ethical dilemmas. From bullying to abuse, racial attacks and children using foul language in public, the show is geared towards the reactions of unsuspecting people put in uncomfortable situations.
It is interesting to see how people handle these interactions. Many people step up and engage in the situation and many others step aside with the notion that it is none of their business. Last week I presented an ethical dilemma but this week is about a question I get asked almost daily, “What Would You Do?”
When people come to me with dental problems and I present different options, they often ask me this question. It is difficult sometimes putting myself in other people’s shoes so I use a concept I learned long ago from a mentor which is – Would I Do It On Me? The acronym is the WIDIOM rule.
Most often there are at least a couple of different acceptable ways to handle dental problems. When someone asks what I would do if I was in their situation, I look at it just like that – If that tooth or those teeth were mine, what would I do knowing what I know?
Let’s look at a specific example. A patient comes in with a tooth that has a big problem. The tooth has extensive decay that involves the nerve and extends below the gum line. I explain to the patient that the tooth can be saved with root canal therapy, some minor gum surgery and a crown or the tooth can be extracted and replaced with a dental implant. The other option is to remove the tooth and leave the space. The patient then asks me the question, “What would you do?”
Any of the treatment options above would be an acceptable way to treat this problem. Depending on the circumstances, I may choose any of the treatment options. I may choose to extract the tooth and not replace it if the tooth is not going to impact me functionally or esthetically. If “my” homecare is poor or if “I” do not visit a dentist regularly, I may choose the dental implant option because of long-term predictability.
This is just one example. Patients also frequently ask me about orthodontics, wisdom teeth and certain cosmetic treatments. In my experience, about 75% of the time the patient ends up doing the treatment that I would do. Regardless of their decision, it seems that for those that ask this question, the information helps them in making a decision that is best for their individual circumstances.
As I was working on this column one morning last week the news became flooded with the “controversy” over dental x-rays and their relationship with a type of benign brain tumor. As I listened to the typical distortion the media puts on everything, I started to do some research on the study.
Next week’s column will address this story. I will discuss the facts of the study and how they relate to the typical dental patient. It never hurts to ask your dentist, “What would you do?”
