DENTAL INSURANCE UPDATE – PART 2

Last week I explained how dental insurance works. This week I will break down the general differences between dental insurances, some things to consider when using your dental insurance, and when it makes sense to consider purchasing insurance if you don’t have it.

I get asked daily by patients who are either self-employed or are not offered insurance through their employer, “Should I consider getting dental insurance?” In most cases, in my opinion, it does not make sense to purchase dental insurance on your own. This goes back to last week’s column as to how dental “insurance” is set up to begin with.

All dental insurance companies set a limit as to how much they will “pay-out” on an annual basis. The industry average is $1000 per year, which has not changed since the inception of dental insurance back in the 1970’s. The premiums for individual dental insurance run around the $700 range. This leaves the patient with a net gain of $300 from the insurance company. This especially does not make sense if you typically only have your teeth cleaned a couple of times a year. The only way purchasing your own insurance may make sense is if you are looking to cover your entire family. You should discuss these factors with your dental office prior to making the decision.

In dentistry, there are a few types of dental insurance available. There is “indemnity” insurance, where patients can go to whoever they want and the insurance will cover a certain percentage depending on the procedure. The other types of insurance are PPO’s, HMO’s and discount plans or “clubs”. With these types of insurance, the dentist has to sign a contract with the insurance company and abide by a pre-set limit they can charge for all procedures. The typical question a dental office gets with regards to these types of insurance plans is, “Why don’t you accept XYZ insurance?”

Most dental offices are small businesses, and the decision for the dentist to sign-up for a particular plan depends on whether they feel they can maintain the quality of care they seek, or were trained to provide, while still being able to cover their expenses to run a business. What corners have to be cut to make this work?

Large corporate dental offices take many of the discounted dental plans that smaller dental offices don’t or can’t take. The business model is different in many ways. Unfortunately, many patients feel forced to choose a dental office based on their insurance vs. choosing the provider.

Continuing education is important for dentists to improve skills and to be able to provide patients with a high level of service. The amount of continuing education a dentist takes is generally related to the resources available from running the business. Although the type of dental insurance a dental office accepts does not always translate into the level of care provided, it is an important factor for the patient to consider.

It is difficult not to get caught in the trap of – I don’t go to the dentist because I don’t have insurance or my insurance only lets me go to a specific dental office. People often have the mindset that dental insurance works the same as medical insurance. It does not.

This is your health. Advocate for yourself and choose to get and stay healthy. There are many things competing for your discretionary dollars. Your dental health should be high on the list, but the conscious choice must be made by you.