Is Your Insurance Expiring?
September 27, 2012
I don’t know how you feel but I think this year is just flying by. I guess I feel like that every year. Only three more months left in 2012. For those of you with dental insurance, only three more months to use your dental benefits before they disappear and go toward the bonuses for the insurance executives. That is kind of a joke and it is kind of not.
As you know, if you have dental insurance, you have a yearly maximum amount of money that can be used for dental care. Although that yearly maximum (typically $1000-1500 per year) has not changed for 40 years in most situations, if you don’t use the money the insurance company keeps it. That’s right, if your insurance company doesn’t write a check out for your dental care, they keep whatever you don’t use.
On that note, if you have dental work that needs to be done, now is the time to do it. The only catch is that because many patients wait until the end of the year to use their dental insurance benefits, it is often difficult to get an appointment. Therefore, those reading this column will be one step ahead of everyone else. The big rush generally occurs in the next couple of weeks so book your appointments now.
This is especially true for patients who need multiple things done. Let me use a specific example. Let’s say your dentist has told you that you need a crown on a tooth but the tooth will need work done by a periodontist or even the dreaded root canal prior to doing the crown. Getting the “pre-crown” work done at the end of this year will allow you to finish the crown in the beginning of next year and maximize your insurance benefits.
It has always seemed crazy to me that we have to play these games with dental insurance, but that’s the way it works. If you have been told that you needed some work done and haven’t done it, call your dental office or insurance carrier to see what remaining benefits you have.
Just for clarification, as this is an area that patients sometimes get confused on, your yearly maximum is yours and not your spouse’s. If you and your spouse have dental insurance and a $1000 yearly benefit, you get to use $1000 and your spouse gets to use $1000. If you go over your maximum you cannot use any of your spouse’s benefits.
For those without dental insurance – you are not missing out on too much. Yes, dental insurance is nice to have, especially if your employer is paying most or all of the premiums. However, people tend to get into the frame of mind that if they do not have dental insurance they can’t go to the dentist.
I had a patient in just yesterday that had not been in for 5 years because he said he did not have insurance. Five years later the patient needs more work done than the insurance benefits will cover. It’s not worth it.
One thing is for certain, regardless of whether you have insurance or not, regular visits to a dentist is the key. If your goal is health you can’t do it alone. If the cost, or the fact you don’t have dental insurance is what is holding you back, talk with an office that offers financial arrangements that work for you. The longer you stay away the more difficult it is to catch up.
Have a great autumn. Beat the rush and schedule those appointments.
The Top Ten
July 13, 2012
This season is often the time there is an influx of new patients being seen in dental practices. Many of the new patients I have seen this spring are people who have not been to a dentist in five or more years. Here is a list of the top ten reasons these patients say they have stayed away from the dental office:
10. Fear of pain
9. Missing work time
8. Moved and haven’t “found” a new dentist
7. Have been out of work
6. My dentist retired
5. Can’t find an office I am comfortable in
4. I don’t like the dentist
3. Economy
2. Lack of concern
And…….the #1 reason people have stayed away from the dentist – Didn’t have insurance.
One of the new patients I saw yesterday (a 40-year-old) said to me, “I haven’t been to a dentist for over five years because I didn’t have insurance. I haven’t had any problems but now I have insurance”.
After examination, this patient was very glad to hear he did not have any cavities. He was not so glad to hear that he had moderate periodontal (gum) disease. When questioned on his familial history he said, “My mother has dentures and I know my father is missing some teeth but I think he’s okay”.
Despite the fact that most people do not know the details about their familial dental history, most seem to know if their parents had/have their own teeth, go to a dentist on a regular basis, and a general knowledge of any problems they have encountered. I always ask this question because it is a good general guideline as to potential dental issues facing the person sitting in front of me.
Luckily for the new patient described above, he will be able to regain most of his dental health with appropriate non-surgical periodontal therapy. However, he was made aware that he has bone loss that will not come back, and because of his genetic pre-disposition for periodontal disease (which affects some75% of the population), life-long maintenance, including hygiene visits every 3 months will be essential to maintain his fragile periodontal status.
And……if his goal is to be healthy and keep his teeth for his life-time, this means every 3 months for the rest of his life…..regardless of whether he has insurance or not. We talked about the annual cost for this maintenance with or without insurance and he was surprised to hear how affordable it is to maintain health.
As I have predicted, due to people staying away from the dentist, dental emergencies are on the rise. I have seen more emergencies (broken teeth, pain, etc.) this spring than I can remember in the recent past. Emergency room dental visits have risen at a staggering rate…..and just so you know, the hospital cannot do anything for you other than prescribe pain medication which often helps only minimally.
I urge you not to put off dental visits. If you have any of the “excuses” listed above, I would suggest re-prioritizing and putting your health at the top of the list. Many dental offices offer complimentary….FREE…initial visits. Talk to the dentist and dental staff about your concerns. There are ways to manage any of these concerns. If the dental office you go to does not listen or does not have a solution, move on to another office. Get a plan that is manageable for YOU!
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?
Dental Insurance Benefits Expiring
December 1, 2011
I don’t know how you feel but I think this year is just flying by. I guess I feel like that every year. Only one more month left in 2011. For those of you with dental insurance, only one more month to use your dental benefits before they disappear and go toward the bonuses for the insurance executives. That is kind of a joke and it is kind of not.
As you know, if you have dental insurance, you have a yearly maximum amount of money that can be used for dental care. Although that yearly maximum (typically $1000-1500 per year) has not changed for 40 years in most situations, if you don’t use the money the insurance company keeps it. That’s right, if your insurance company doesn’t write a check out for your dental care, they keep whatever you don’t use.
On that note, if you have dental work that needs to be done, now is the time to do it. The only catch is that because many patients wait until the end of the year to use their dental insurance benefits, it is often difficult to get an appointment. Therefore, those reading this column will be one step ahead of everyone else. The big rush generally occurs in the next couple of weeks so book your appointments now.
This is especially true for patients who need multiple things done. Let me use a specific example. Let’s say your dentist has told you that you need a crown on a tooth but the tooth will need work done by a periodontist or even the dreaded root canal prior to doing the crown. Getting the “pre-crown” work done at the end of this year will allow you to finish the crown in the beginning of next year and maximize your insurance benefits.
It has always seemed crazy to me that we have to play these games with dental insurance, but that’s the way it works. If you have been told that you needed some work done and haven’t done it, call your dental office or insurance carrier to see how remaining benefits you have.
Just for clarification, as this is an area that patients sometimes get confused on, your yearly maximum is yours and not your spouse’s. If you and your spouse have dental insurance and a $1000 yearly benefit, you get to use $1000 and your spouse gets to use $1000. If you go over your maximum you cannot use any of your spouse’s benefits.
For those without dental insurance – you are not missing out on too much. Yes, dental insurance is nice to have, especially if your employer is paying most or all of the premiums. However, people tend to get into the frame of mind that if they do not have dental insurance they can’t go to the dentist.
I had a patient in just yesterday that had not been in for 5 years because he said he did not have insurance. Five years later the patient needs more work done than the insurance benefits will cover. It’s not worth it.
One thing is for certain, regardless of whether you have insurance or not, regular visits to a dentist is the key. If your goal is health you can’t do it alone. If the cost, or the fact you don’t have dental insurance is what is holding you back, talk with an office that offers financial arrangements that work for you. The longer you stay away the more difficult it is to catch-up.
But I Have Dental Insurance
October 14, 2011
It should come as no surprise that the insurance industry is out to make a profit. It’s a business just like any other business. Any place an insurance company can cut costs or deny a claim is more of a profit to them and that is their goal. Unfortunately, this is not always in the best interest of the patient.
When my son was born 15 years ago he could not keep anything in his stomach. We went through a battery of tests to determine the problem. Not once did I think, “I wonder if the insurance is going to cover this?” When the diagnosis was made and it was determined that surgery was needed when he was only 10 days old, not once did I think to check with the insurance company to see if it would be covered. When all was said and done the insurance company said that we owed $10,000. I had the normal reaction that anyone would have – How could I owe $10,000 when I have insurance?
Dentistry is a little different. There are not too many situations where a life or death threatening has to be made or the dependency on insurance coverage needs to be assessed immediately. Many dental insurance companies suggest that a pre-determination of benefits be submitted prior to any work being done. The reason for this is to control what is being done and to delay the payment of a claim. The longer an insurance company delays a claim the longer they have their money and they know that longer time periods lead to the possibility of the patient not following through with the work.
I recently had a claim rejected by an insurance company for periodontal scaling and root planning (a.k.a. deep cleaning). This is a procedure done on people with periodontal disease to remove calculus (tartar) and bacteria below the gum level. The claim was submitted with the necessary documentation showing clear evidence (in my professional opinion) of periodontal disease and the need for treatment. What does this say to the patient? The patient put trust in the doctor to make the diagnosis and suggest the necessary treatment but the insurance company basically said that the treatment wasn’t needed. Not needed? How do you explain that to a patient?
What happens if I say, “Your insurance company said that you do not need this procedure, so I guess you don’t need it?” Two things happen. One is that the patient does not get the treatment needed, determined by someone sitting behind a desk who has never even seen the patient. The other is a huge increase in liability. When the patient’s periodontal disease continues and the person ends up losing teeth, who is responsible? You would logically think that it would be the insurance company who denied the treatment. This is not the case. The ultimate liability falls on the dentist for not managing the disease.
Patients need to be educated on their conditions. We live in an insurance dependent world. Just remember – your insurance company doesn’t care about you the same way your doctor does.
Getting Ripped Off? – Part 3
May 29, 2011
For the last couple of weeks we have been discussing an online column that was forwarded to me called “Is Your Dentist Ripping You Off?” If you missed any of the columns, be sure to look them up online. This week I wanted to discuss more of the comments readers made after the column was published.
Many of the comments are rants from obviously angry people. As I read through the 9 pages of comments, it is obvious that people are mad about the cost of dentistry and things in general. It is also obvious that many of the contributors have a very negative opinion of the profession. This is a disturbing trend.
What does the following comment say about this particular person’s view of dentistry? “It is about time dentists got investigated. They over charge, they underpay and take advantage of their staff. Why do they use dangerous toxic materials like mercury in fillings?…….and the unnecessary braces they subject little kids to. They actually x-ray the whole head. This industry is ripe for massive investigations. Hopefully it will happen before more people are damaged by unnecessary or shoddy work.”
In addition to this comment being highly inaccurate, it is coming from someone who is probably angry at life in general, let alone dentistry. The point is that this is the trend. People are losing trust in professions that used to be well respected. Why? Life isn’t getting any easier. The cost of living seems to be continuously rising and loyalty and trust are slipping away as a consequence of just being able to make ends meet. As disposable income decreases, people are spending less on things they do not feel are essential.
I discussed a comment last week from someone who was complaining about the cost of a crown. What if you need 10 crowns and the cost is $15,000? Let’s get one thing straight – no one needs crowns. You may need a crown or 10 to save your teeth but you always have the option of taking the teeth out. That would cost a lot less. Someone might say – I can’t justify spending $15,000 on my teeth. There are people who will spend $40,000 on a car that they drive for 5 years and trade in for $10,000. Most people use their teeth more than they use their car and the teeth don’t depreciate. It is the responsibility of the dentist to educate the patient so that the patient can make the most informed decision on what is right for them.
Unfortunately, dentistry is not getting cheaper and the broken system we call dental insurance is not getting any better. So, for now, dentistry is one of those things you have to decide where to place on your priority list. Just keep in mind that your health, including the health of your teeth, has a direct effect on the quality of your life.
Now, as far as this trend of losing trust and loyalty, you have to make a decision about where dentistry falls on your priority list first. If your dental health is not important to you, you could be the one making all the negative comments about dentists and dentistry, probably do not go to the dentist on a regular basis, and will most likely suffer the consequences. If your dental health is important to you, seek someone you like and trust as a person. If you find that person, they will make sure to take good care of you. You have a choice.
Getting Ripped Off? – Part 2
May 22, 2011
Last week I told you about an online column that was forwarded to me called “Is Your Dentist Ripping You Off?” Basically, the author was questioning why there can be such a discrepancy in fees or treatment plans between dentists. The author also gave suggestions on how to pick a dentist and did note, “Don’t select a dentist on price alone.”
This week I wanted to discuss some of the comments that readers made after the column was published. It is interesting to note that there were people on both sides of the debate. The first comment came from a dental assistant. She says, “It is fair to comparison shop but remember that cost is not always the best evaluation tool. It is a much better idea to check around with people you trust to see if they like their dentist.” She goes on to say, “Most dentists like their patients to be informed about their health and partner in all decisions. In our office, patients are always given the optimal solution as well as the options and their pros and cons.”
I would agree with these statements but would add that you, the potential patient, make the ultimate decision as to who your dentist is. Just because someone else “likes” a particular dentist does not mean that person is right for you. Although it is impossible for you to be able to evaluate the clinical skills of a particular dentist, which is unfortunate, the most important factor is that you trust who you are going to.
Here is a comment from another reader. “What’s disgusting is that the dentist pays the lab about $450 for a crown and marks it up 200% or more. What happened to the accepted profit margin for a business of 20-30%? What a rip.”
Can dentistry be expensive? Absolutely. Who is to blame? Is it the insurance companies that have not raised their yearly maximums since 1970? Is it the dentists who are price gouging? Is it the dentists who are over treating? Is it the government? I think of solutions for this all the time but always come up dry. There are so many factors. I have never heard one solution that fixes all the problems. If you have one, I would love to discuss it.
Here are some of the issues. Today, as I understand it, the cost of an undergraduate education at Tufts University is about $52,000 a year. That’s over $200,000 to get a bachelor’s degree. To be a dentist you have to spend at least four more years in school. Tufts Dental School is currently around $75,000 per year. That is another $300,000 to bring the total cost of 8 years of education to over $500,000. That is a tough nut to swallow on graduation day with no job, no income, no house and a beat-up car. I’m not saying you should feel badly for those poor dental graduates; I’m just saying it is a factor.
Any small business owner will tell you that running a small business is a challenge. Dentistry is no exception. The average overhead for a dental practice is tough to say because it depends on where you are in your career, what type of office you have, and where you practice. However, I can tell you it is high. Again, we dentists are not looking for sympathy: I’m just saying it is a factor.
There are other factors for cost such as the perceived level of expertise of a particular dentist, the quality of the laboratory used (which makes a huge difference), continuing education expense to keep current,demographics, etc. I will discuss more of these next week when I review some other interesting comments.
But I Have Insurance
February 11, 2011
I had a reader e-mail me an insurance related question this past week and wanted answer that question as well as a couple of other insurance related issues.
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. So, 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 pay something. Any amount that reduces your out-of-pocket expense helps.
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.
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.
If you have any other insurance related questions please e-mail them to me.
Do Just What My Insurance Covers
November 19, 2010
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. So, 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 pay something. Any amount that reduces your out-of-pocket expense helps.
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 you dentist’s responsibility to recommend what you need.
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.
