THE STATE OF DENTAL INSURANCE IN 2020 – PART 4

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

The dental insurance industry is getting more and more competitive. Insurance companies are looking to increase profits, and those purchasing dental insurance (usually employers) are mindful of the cost of plans. To increase profits, insurance companies either have to continue to increase the cost of their premiums, or decrease their expenditures. Employers certainly do not want to see an increase in premiums. So, most insurance companies are trying to remain competitive by keeping their premiums lower but paying out less in benefits.

This is happening at a rapid rate, and under the radar of those who are supposed to benefit most from the insurance – you, the consumer. Here is the typical scenario:

At the time of the year when employers are looking to renew their plans, typically the spring, they are presented with their options. When they look for the plan they had the previous year, they realize it is not available anymore. The choices they are now given are either to increase the premiums they pay out for each employee, or to choose a new plan that is at or below the cost of their previous year’s plan with less benefits and more restrictions.

What changes when the employer chooses the second option? These plans are typically those that dentists must “participate” in order to be a part of. Prior to insurance companies offering these plans to employers, they have approached dentists to try to get them to participate. It is up to each individual dentist to determine if they choose to participate. If they choose to participate, to be an “in-network” provider, they agree to accept the contracted fees set by the insurance company. That, in itself, is not necessarily is a bad thing. Some insurance companies offer reasonable and fair reimbursement.  However, there are often other compromises that interfere with the provider/patient relationship.

If an employer chooses one of these plans, the employee (and their family) may need to make a decision on what is most important to them when it comes to their oral health care. What happens if the dentist you have been seeing chooses not to participate in that particular plan? You have to decide whether to stay with that dentist as an out-of-network provider, or choose a new dentist who has agreed to be in that plan. Many of these plans have limited providers.

How do you decide whether to stay with the dental office you have been going to for years, or switch? It is your choice. It can be a difficult decision. There are many things which need to be taken into consideration to make this decision. My best advice is to talk to your dental office/dentist about it.

Although there may be financial differences between some providers, in most cases, it may not be as much as you think. There are many excellent dental offices and dentists on the North Shore. The most important consideration, in my opinion, is to be in an office where you like the people and feel comfortable and confident that you are being treated with your best interest in mind.

Are your expectations being met or exceeded at your current dental office? If they are, and all of a sudden your dentist is not on the list of your new insurance carrier, don’t jump ship until you consider everything. And, as I said, talk to your dental office team and get their take. If you do decide to leave and don’t like your new office, I’m sure they’ll take you back.

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. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.