Archive for the ‘Dental Insurance’ Category

A few days ago the United States celebrated Independence Day, the 4th of July. While most other countries around the world have a 4th of July, they don’t have a particular reason to celebrate it. (Especially Great Britain). We celebrate the signing of the Declaration of Independence from Great Britain in 1776, because we were tired of some government far away telling us what to do.

We Americans savor our independence. We enjoy being able to decide for ourselves what we want to do, and when and how we want to do it! Hand in hand with this privilege is the need to accept the consequences of our behaviors. Americans have always recognized and appreciated this fact as well.

I think we as a nation are forgetting the value of our personal independence and accepting consequences of our actions.

We spill hot coffee on our laps and want to blame the coffee vendor. We drive way too fast and blame the car manufacturer when we roll our vehicle. We crave fossil fuels and then vilify somebody making a mistake when trying to fulfill our wants.

Ok, I know there are two sides to all issues, but I see too many places where we don’t accept the responsibility for what we do. We also let others tell us what we can and can’t do.

Since I am a dentist, I have to throw in some dental applications here… too often dental insurance tells us that of many potential options, we can only do one, and we just passively roll over and submit. Dental insurance does not evaluate a patient’s needs or wants – just says one procedure should fit everybody. I get really frustrated with that! In spite of what any insurance plan may or may not cover, I try to offer patients the very best treatment and all the options that make sense.

Where is our independence, America? Don’t give up on personal choice! Relish the idea that we get the consequences of our own actions! Make them count!

(And take care of your needed dental work as well!)

Many people have dental insurance; few admit to understanding it. So I thought I’d mention a few things about how dental insurance works.

Traditional dental insurance began back in the late 50’s or early 60’s. It will typically pay a high percentage (often 100%) of dental treatments deemed to be diagnostic or “preventive”. This usually includes examinations, needed x-rays, and cleaning teeth.

When teeth have cavities, and need to be restored, these insurance plans usually cover about 70 – 80% of the fees. Many plans will only pay for silver fillings in back teeth; if a patient elects to do bonded composite restorations (white fillings) which might cost more, the plan will only pay for what the same filling in silver would have cost.

When a tooth is more badly broken, when it has more filling than tooth structure, or if it is cracked, a crown may be required to properly restore the tooth. To repair damage an infection or abscess has caused, a tooth may require root canal therapy. Often missing teeth should be replaced to restore balance and healthy function. All these procedures are called “major” work and typical insurance plans only cover 50%.

So you have some procedures covered at 100%, some around 80%, and some only 50%. But there are more conditions to know about! Whatever treatments are required, the plan will pay the percentages mentioned only up to a yearly maximum. This amount is often between $1,000 and $2,000. I find it interesting that 50 years ago, when this type of insurance got its start, the yearly maximums were the same as they are now! Back then you could buy a new Volkswagen for that amount! What does a new VW cost today? Why haven’t insurance rates kept up? (OK, I’ll get off my high horse now) (Or high VW)

One more consideration… the percentages mentioned above are sometimes calculated on insurance’s tables of what “usual and customary” fees are. Often these tables are considerably out of date. (like that 60’s VW)

Another whole type of insurance is “managed care”. These are plans where the insurance provider cuts a deal with certain dental offices to provide discounted fees for people on their lists. Usually the dental office tries to make up lost fees by increasing volume of patients seen (Or volume of treatment rendered). Often there are procedures that are not covered or not available with these plans.

The most important thing to know about insurance is that YOU are in control of your health. You and your dentist should decide what makes the most sense for you, both now and for the long term. Don’t let any insurance plan compromise your health and comfort!