My team and I get a lot of questions about dental insurance: “Why isn’t your practice in my plan? Why didn’t my dental insurance cover this? Why can’t I just have done what my insurance covers?”
Let me shed some light on dental insurance. I will start with defining insurance in general; share a little history of dental insurance; describe what dental insurance looks like today and where it may be in the future; and expose the true relationship (or lack of) between long term dental health and dental insurance.
Insurance is intended to protect us from catastrophic loss. If your home is destroyed by hurricane or tornado, homeowners insurance may allow you to rebuild. Medical insurance will pay for an emergency appendectomy or heart bypass procedure. In both examples, the risk of buying insurance is determined by you providing detailed information about what is being insured (your home, your health, etc.) so the risk can be calculated and a premium charged.
On the other hand, dental “insurance” does not inquiry about your current state of dental health but instead provides a “one size fits all” approach to coverage. You are not asked about your dental history or current dental health. Yearly benefit limits in dental insurance have no relationship to the condition of your mouth but exist only to limit costs to the employer or provider of the insurance. As a result, dental insurance is not really insurance, but simply a pre-paid specific benefit that has no relationship to your own state of dental health or disease. It’s good to have some benefit, but that doesn’t make it insurance.
The nature of dental “insurance” has changed considerably since introduced by General Motors in 1971 to make employment in their plants more attractive. Back then there was no limitation on which services were covered; the fee for a crown was $175 and the maximum was $1000 of total treatment per year. By 1990 the fee for a crown was $500 but the yearly maximum was still $1000. By the year 2000 a crown fee was $800 and the yearly maximum still $1000; today the yearly maximum is still $1000 and the fee for a crown is over $1000. The clear trend in dental “insurance” is to control costs by limiting the yearly benefits in addition to shrinking the scope of procedures covered. Think of dental insurance as a gift card you can use towards your care, but this gift card has shrunk over the years.
PPO stands for preferred provider organization, one form of dental insurance. Dentists who participate in these insurance plans agree to accept a lower fee for these groups of patients, somewhere between 20-40% lower than their normal fee. In the year 2000, 50% of dentists participated in PPO plans – today that number is over 80%. There are three consequences to this trend for you as a dental patient. First, to make up for the lost revenue by accepting the PPO plan, dental offices must increase the volume of patients treated and the pace of care for the same level of income. This means less time discussing what you want for your dental health; less time learning about how to prevent disease for the rest of your life. Second, patients in PPO plans may find limited access to dental care in these practices because the fees collected for the PPO plan are significantly less than patients who pay normal fees. This can means long wait for appointments or emergencies. Lastly, patients in the PPO plan pay one lower fee and everyone else in the practice pays a different higher fee. With only about 50% of Americans having any dental insurance at all, does it seem fair that people without dental insurance pay a higher fee in a PPO practice than someone on the plan? We don’t.
We are not a preferred provider for any PPO dental insurance plans – you can still use your PPO dental insurance in our practice, but it will cost you more than at dentists who are “in your plan.” We do not participate in these “plans” because we believe the way to treat you with respect and dignity means we must take the time to understand your goals, expectations, circumstances and problems. We must take the time to learn the cause of your dental problems so they can be eliminated. We must take the time to teach you what is going on in your mouth, so you can be active in developing and choosing a long term plan for dental health that fits into your life. It is not possible to take this much time in a high-volume fast-paced PPO dental office, and we don’t believe that is the right way to care for people. We do not treat a high volume of people or provide treatment at a fast pace because this is dehumanizing – treating people like parts on an assembly line.
What is the relationship between long-term dental health and dental insurance? If you rely on dental “insurance“ to get or keep you healthy, you will be disappointed to experience problems in your future that simply cannot be addressed by dental insurance alone. Dental decay, gum disease and “bad bite” are why people lose their teeth, and dental benefits may be greatly limited to effectively treat these basic problems.
You can eliminate your need for dental insurance by finding a dentist who takes the time to help you be healthy rather than just race you through a system that attempts to fix disease. You can learn how to take charge of your dental health and not spend your life “fixing” your teeth. That is what you will find in our practice.
The three keys to dental health:
With our approach to dental health, there is a very good chance you not only won’t need dental insurance – you may not even need a dentist!