My thoughts on dental insurance...

Dental insurance is one of those things that is constantly on your mind when you are a dental professional. Unfortunately, our society has become more and more insurance dependent, so most American's absolutely rely on their dental insurance to receive dental care. I wanted to touch on a few points to keep in mind when thinking about dental insurance.

temp-post-image

Insurance companies are some of the richest companies in the world. They have significant influence with legislators in Washington DC and Austin. The amount of money they spend on lobbying every year would blow your mind. They didn't get rich by writing checks. They got rich by denying claims but still collecting premiums. Thats really the bottom line. When you have a dental insurance, you need to understand that their interest is profit, not your dental health. Because of this, they will go to any extent to not make payment on claims. They are not your partner in health. They exist to extract money from you and make your life difficult if you ever need a procedure done.

temp-post-image

At least every week, I see a patient who has a tooth that needs to be replaced. In many instances, the best replacement for that patient would be an implant. At least half the time, their insurance doesn't cover implants. The insurance company made an arbitrary decision in an attempt to cut their costs to not cover implants. Many times, my patient then has to opt for a treatment that is not the best treatment for them because the insurance won't pay on the implant claim. How can these insurance companies claim that they are your partner when it's obvious they only care about their bottom line and their profit?

temp-post-image

Now, I understand that it isn't reasonable to expect everyone to kick their dental insurance to the curb and pay cash for everything. That's not the world we live in. But I would hope to influence the way that our patients think about their insurance. Dental insurance is very confusing and the insurance companies rely on this confusion to get away with executing their crumby policies without anyone noticing.

temp-post-image

First and foremost, we have the in-network/out-of-network phenomenon. Luckily, the legislators of the great State of Texas have mandated that insurance companies with PPO plans can not restrict your right as a patient to see any dentist you want. If you have a PPO plan, you can see any dentist you please, whether or not they are in-network providers for your insurance. There is a lot of confusion as to what this means. As a dentist, if I sign up to become an in-network provider for an insurance company, I have to sign a legal agreement with them. That agreement comes via a 10-20 page contract that has all sorts of crazy stipulations. These stipulations can severely limit the care that we can provide to our patients. They are very restrictive and unfair and it becomes even more difficult to extract payments from them. Obviously, some are worse than others. As of the date that this blog post is being written, we are in-network providers for Delta Dental Premier, Humana, Aetna, United Concordia and Guardian. One of the biggest dental insurance companies is Met Life. We are NOT in-network with Met Life. Met Life is pretty easy to work with when out-of-network. They pay pretty quickly and easily. They don't make us jump through as many hoops. Once a dentist signs up to be in their Preferred Dentist Program (PDP), things get messy. All of the sudden, payments are delayed, denials go up, life gets difficult. In addition, as an in-network provider, the dentist is required to charge specified fees that are about 40% lower than the usual and customary fees. This may sound great as a patient, but what many dental offices do to combat this is add on unnecessary procedures and up-sell to recover this loss in fees. This is something that I see commonly when I am giving a second opinion.

temp-post-image

So what are you to do as a patient and how does this affect you? That's a really a question of personal philosophy. Some patients want to spend as little as possible and are willing to sacrifice trust and comfort for a lower fee. If that is the case, then stick to in-network dentists and go to which ever office is offering their best new patient gimmick and switch around to a new dentist every time you go. Will you get the best care this way? No. Absolutely not. But thats the price to be paid for minimizing costs…and that's okay as long as you are making that conscious choice.


Would you prefer more continuity in your care? Would you prefer to see the same dentist at every visit? Would you rather have some consistency in your dental visits? If you answer yes to any of these, then you are probably best served finding a true "dental home." I would like to think that we can offer that to you. If we are out-of-network for your plan, it will usually end up costing about 10% more about of pocket than what it would be to go to an in-network provider. Is that 10% extra worth it? I think it is. For me it would be. For someone else, maybe not. It's your decision to make. My hope is that we make patient's for life. I want to treat you and your family for the long haul. Thats valuable to me. The relationship that I have with my patient's is too valuable to let an insurance company get in the way.

If you are currently our patient, awesome! I hope that we can serve you well enough to keep you around for years and years. If you were our patient at one time but moved on because of your dental insurance, we would love to have you back. I hope that we can prove our worth to you. If you are not our patient yet, we hope you will consider us when you decide you need a new dentist.

As always, I am always available to answer your questions.

Thanks for sticking with me through this whole article!