In 1965, two million people were covered by dental insurance. Presently, over 64 million people have insurance plans. Since dental insurance is a major fringe benefit in many companies, it is rapidly playing an increasingly larger role in helping people obtain dental treatment.
We strongly feel our patients deserve the best possible dental care we can provide. In an effort to maintain this high quality care, we would like to share with you some facts about dental insurance.
Dental insurance is meant to be an aid to help restore your mouth to sound dental health.
It has been the experience of many dentists that patients have gotten the impression their insurance plan will pay up to 80%, even 100%, of their dental fees. In spite of what you are told, we have found many plans cover between 40-50% of an average fee. For the same procedure, some plans pay more — some less. The amount your plan pays is determined by how much your employer paid for the insurance plan. The less paid for insurance, the less you will receive in benefits. The more paid, the better benefits you will receive.
It has been the experience of many dentists that companies sometimes tell their clients certain dental fees are “above the usual and customary fee”, rather than tell them that the insurance benefits are too low.
We know that some companies do not update fee schedules regularly, even with the cost of living index. Remember, since the insurance company must make a profit, you can only get back in benefits what your employer puts in, less the profit the insurance company wants to make.
Please read your policy so you are fully aware of any limitations of the benefits provided. Insurance carriers do NOT cover many routine dental services. In fact, some preventive procedures are not covered at all. We are happy to cooperate with any patient whose treatment is covered by dental insurance.
Insurance is submitted after each visit. The patient, however is responsible for the total fee and will be expected to make up for any deficiencies in the insurance coverage.
A Word to the Wise:
An Explanation of Third-Party Payment for Dental Care
In recent years, there has been a significant increase in so-called “managed dental health care” in which insurance groups make contracts with local companies to provide dental care for specified fees and with numerous regulations and stipulations for patients. Your employer may decide to provide dental benefits for you using a managed care concept with its advantages and disadvantages. Other than paying for dentistry yourself without any involvement with insurance companies, there are several payment concepts currently popular:
PPO (Professional Provider Organization)
Note: These organizations offer dentistry at reduced fees as provided by specified practitioners.
A dental benefit company (PPO) contracts with your employer to provide dental care for you. The dentists who participate in the PPO plan agree to treat you for reduced fees. They are called “preferred providers.” Usually, only a few dentists in a community participate. Often, they are younger dentists, or a few mature dentists who have various reasons for their participation. Many dentists do not participate in PPOs because the reduced fees limit the dentists’ ability to provide services at their usual level. Dental benefit companies administering PPOs are in “business” for profit. The profits go to the PPO owners. With the myriad new innovations in dentistry, it is impossible for updated practitioners to provide high-level, standard-of-care services on a continuing basis to you at reduced fee levels. Be careful! If you elect to join one of these plans, you can expect only maintenance level care, usually without elective services such as implants, esthetic dentistry, orthodontics, and other treatment.
HMO (Health Maintenance Organizations)
Note: These organizations offer minimal dentistry at low fees by specified practitioners.
Perhaps the greatest current threat to quality dental care in the U.S. are the currently available, underfunded dental HMOs. A dental benefit company (HMO) makes a contract with your employer to provide “overall” dental care for you at very low fee levels. Capitation payments to dentists from many dental HMOs will not even provide the total of 2 dental “cleanings” (scaling and polishing) per year. The dentist receives a few dollars per patient per month, whether the patient is treated or not. Obviously, the dentist would rather not see the patient, and certainly would rather not do any expensive treatment, almost all of which must be donated to the patient by the dentist. Generally in dental HMOs, the dentist can only survive financially by not treating the patients. Who profits from dental HMOs? Certainly not the patient or dentist. You guessed it, the HMO owners! As in some PPOs, if you elect to join a dental HMO, you have a group of preferred providers who participate in the plan for various reasons. Fortunately, after numerous companies have come and gone, the use of dental HMOs is diminishing. On the other hand, there are a few large dental HMOs with historical evidence of relatively acceptable levels of dental care. However, these are exceptions to the previous statements. Your dentist can easily tell you if the dental HMO plan you are considering provides adequate funding for dental services
Traditional Indemnity Dental “Insurance”
Note: These organizations offer standard dental treatment at near normal fees with a choice of practitioners.
These groups are the original managed care organizations in dentistry. Many dental patients have been on these plans for decades. They provide payment to dentists at fee levels that generally allow quality oral services to be provided. One of the only disadvantages to some of these plans is the high administrative-cost charged to you and your employer. Thus, you receive less dentistry than the funds your employer pays into the benefit company. Nevertheless, this traditional indemnity “fee for service”, freedom of practitioner choice, dental “insurance” plans have provided excellent dental service for Americans for decades.
A growing form of managed care is the so-called “referral network”. Dentists join a commercial firm, such as 1-800-DENTIST. These groups have recruited dentists and can give patients knowledge of the qualifications of the dentist. These dentists provide services at somewhat lower fees.
Direct Reimbursment Plan
An excellent and growing form of payment called Direct Reimbursement (DR) can be obtained by your employer, in which you have complete freedom of choice about practitioners and the quality level or type of service you want, without major overhead costs to your employer. We will be pleased to provide information on DR if you want it for your employer.
Americans enjoy freedom in nearly all areas of their lives. I think you want to choose your health practitioner based on your own criteria, and you want the very best preventive-care practitioners and treatment you can get. I doubt if you can trust profit-motivated companies to select your practitioners, dictate their fees, or limit their services. Only three of the five methods for payment described above preserve “freedom of choice” dentistry (traditional indemnity dental “insurance” plans, referral networks, and direct reimbursement).
Thank you for your support. We look forward to serving you with high quality, moderate cost, freedom of choice, dental services.