Archive for July, 2008

Often I get the question “My insurance company gives me a list of dental providers…why aren’t you on that list?” Well, let’s talk about dental insurance for a while…

The way I understand it, fee for service dental insurance came into existence in the mid 60’s. (I wasn’t a dentist back then!) The insurance plans were designed to pay for needed dental treatment, up to a yearly maximum benefit. That benefit was around $1,500. In the mid 60’s, you could buy a showroom fresh new Volkswagen for $1,500! That amount that would accomplish a tremendous lot of dentistry in those days. (gas was typically 31 cents per gallon or less, too!) Unfortunately, in the last 40 plus years, prices of everything have gone up. Today’s Volkswagen will cost well over $15,000 – yet the typical dental insurance plan still covers the same dollar figure as in 1965… $1,500. Modern dentistry costs more today, too. I think it is best to think of dental insurance as a coupon that gives you a substantial discount on your dental needs; who wouldn’t appreciate coupon like that?

More recently, insurance companies have developed an alphabet soup-like array of plans… PPO’s, DMO’s and other such names. Basically, these all have one thing in common. The insurance company gives the patient a list of dental providers to choose from, calling it the “in network” list. They tell the patient the dentists “in network” will provide needed dental treatment and the insurance company will reimburse the patient at a higher percentage than if they see an “out of network” doctor. The dentists on this list have agreed to work for a lower fee, pennies on the dollar, for patients in these plans. Many dentists have found it is impossible to present patients with the finest dental treatments and personal service while working for the fees dictated by these plans. So often the treatment, the facility or the service suffers.

Another thing to watch out for with insurance coverage, is just that… what do they cover? Some will say they cover one procedure, but not another. Silver vs. white fillings, gold vs. porcelain crowns, implants or not. Plans can be very confusing, with time limits, exclusions for pre-existing conditions, and coverage for some teeth but not others. Your dental office should be able to wade through the fine print and help you get your benefits. Be sure you know what you are getting!

If you have dental insurance, rejoice! It can give you a head start on maintaining your dental health! Just be sure that you don’t let your insurance coverage compromise the treatment that you deserve.