THE STATE OF DENTAL INSURANCE IN 2020 – PART 3

If you missed any of this series, they can be found at www.thetowncommon.com.

Is there a solution to the dental insurance problem we have in this country? Solo dental practitioners may look at it one way, large dental chains see it from a different angle, consumers have varied opinions, and many insurance companies see it in their own very different perspective.

Ask someone how they feel about their medical insurance, and they might say that premiums are too high, deductibles are too high, they can’t go to who they want, it’s tough to get appointments sometimes (especially with specialists), etc. Employers looking to cut costs obviously tend to choose lower cost plans. That usually increases deductibles and may limit which providers the employee is able to see. Depending on your insurance, you may have decreased benefits or none at all, if you see a provider outside of “your network”.

What does “in-network” vs. “out-of-network” mean? A long time ago, if you had insurance, you could go to anyone and use your benefits. PPO’s and HMO’s eventually formed and were able to provide lower premiums by contracting with providers who agreed to a discounted fee for their services – the “in-network” providers.  Providers who do not sign that agreement are considered “out-of-network” providers. Your insurance company decides your benefit level for both in and out-of-network providers. The goal for the insurance company is simple: pay-out as little as possible for the biggest profit.

This is the way dental insurance is trending in this country. There are fewer plans being offered that will allow you to use your benefits with providers outside of their network. Why? It depends on who you ask, but I believe the primary reason is to control costs. And that is understandable…if you’re the insurance company.

If you were running a business with a 70% overhead and a major supplier of your revenue decided they were going to pay you 30% less, would you be able to run your business the same way? Of course not. You would need to do things faster, do more of it, and control your costs by investing less in the business, using cheaper materials and paying people less. There is only one winner in that game. The alternative is to not accept the 30% less, have fewer customers, and run your business the way you see fit, in the best interest of your customers.

You can’t be very happy reading this, as a business owner, employee, and/or consumer. It is important to advocate for yourself, especially when it comes to your health.

I frequently get asked, “Should I consider getting dental insurance?” by patients who are either self-employed or are not offered insurance through their employer. In most cases, in my opinion, it does not make sense to purchase dental insurance on your own – at least the way that dental insurance currently works. You should definitely talk to your own dentist about that prior to purchasing something.

What happens if your dentist doesn’t take (or isn’t in network) with your insurance anymore? Should you stay? How do you find a provider in your network if you choose to leave? What other things do you need to consider in making a decision?

….to be continued

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com.