The Facts of Life About Dental Insurance (Part 1)

A real-world look at the practice of dentistry from the perspective of Dr. Clary...

During the past decade, dental benefits plans have become an integral part of health care planning for many families. These plans are made available to employees or members, through companies, unions, and associations, and may vary considerably from one plan to the next. Today approximately 80% of our patients have a dental benefit plan in one form or another. 

But are we, as dentists, helping those "4 out of 5" gain a clearer understanding of what this benefit actually entails? In many cases, "No". In few cases, "Hell No". The better we can help our patients UNDERSTAND what their insurance benefit is all about, the more effeciently and effectively we can operate our practice. And the smoother a practice operates, the easier it is to market.

So, to that end, here is one way of explaining dental insurance to your end users.

First of all, dental “insurance” is not insurance in the true sense. Insurance such as life, auto, and household is based on the likelihood that death, accident, fires, and theft will not occur. Dental “insurance” on the other hand, is based on the likelihood that the beneficiary will use dental services. 

Therefore the premiums paid for the dental “insurance” policy determines the amount of benefits paid. The greater the premium, the greater the benefits in dollar amounts available and/or the dental services covered. Thus, dental “insurance” was never designed to cover the total cost of all dental treatment. A better term would be “dental assistance” program.

Unfortunately, many people have an inflated view of what their dental insurance is going to pay. The insurance carriers have frequently promoted this misunderstanding themselves. This is especially true if it is a new policy.  The fact is that most policies pay 80% to 100% of preventive procedures such as exams, x-rays, and routine cleanings (dental prophylaxis), 50% to 80% of routine procedures such as regular fillings, and 0% to 50% of the more expensive and extensive types of reconstructive dentistry such as crowns, bridges, and dentures. 

In addition, many policies place age restrictions on such procedures such as fluoride treatments, and will only cover certain procedures once every so many months regardless of the actual dental need of the patient. Also, most policies have yearly deductibles in the range of $25 to $50 per person as well as yearly maximums usually in the range of $500 to $1000 per person, or occasionally a lifetime maximum. Patients also need to be aware that some policies do not cover procedures such as orthodontics, crowns, bridges, and more extensive dental cleanings or gum treatment regardless of the patient’s actual dental needs.

Basic to us, oftentimes as clear as mud to our patients. The more consistent we are in spreading the message, the more we can help our patients to effectively maximize their benefit.

In Part 2 of this series, we'll dig deeper into the benefit.