Posts Tagged ‘managed care’

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 Often these tables are considerably out of date.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!