5 Things I Wished Patients Understood about Dental Insurance
Sometimes the best way to say it is with blunt honesty.
Some of these truths may seem obvious, but you’d be surprised how well dental insurance companies, insurance agents, & employers mask the pitfalls of dental insurance plans.
Dental insurance companies don’t care about you.
This is truly the foundation of understanding the what, why, and how of dental insurance companies. Please do not forget that dental insurance companies are large multi-billion dollar machines that prioritize profit over the well-being of patients. Dental insurance companies do not care about what’s “best” for the patient; they care about minimizing waste & maximizing $$$.
Dental insurance & medical insurance are not the same.
The way dental insurance works is drastically different from medical insurance. There is no maximum deductible that’s reached until your dental insurance kicks in. At best, dental insurance is a discount plan that can be used under very limited & specific conditions. These conditions are set forth by… the dental insurance company.
Dental insurance companies purposefully make things difficult.
If you review #1, you’ll begin to understand why dental insurance companies have developed techniques to make the process of claims & reimbursement for all parties involved extremely difficult & frustrating. Examples of these tactics include fine-print clauses in your dental contract (preexisting condition clauses, LEAT, missing tooth clause, & etc), long waiting periods, back & forth claim denials, requests for additional documentation then “losing” documentation, hours of wasted time on hold with a representative, & much more.
Your dental insurance annual maximum is not a guarantee.
Dental insurances and insurance agents love to market their “annual maximum”. “You’ll get $5000 every year to use!” “You can use that $5000 on any type of dental treatment!” Unfortunately, it’s just not that easy. There’s nothing easy about dental insurance. The annual maximum is not a guarantee, & the only entity that decides whether you or the doctor gets reimbursed is… the dental insurance company.
Refer back to #1 and #3.
In-network doctors are not always better & “cheaper”.
Many patients assume that because a dentist is "in-network” with insurance, it automatically means that the cost of their treatment will be cheaper. This is not true in many cases.
How is that possible? Reimbursement rates for most dental insurance companies are low & barely cover the cost of materials & labor. Some offices “make up” for these low reimbursement rates in different ways. One way is by adding various codes, treatment, & surcharges that are not covered by your dental insurance. At the end of the day, your insurance may be maxed out, & your out of pocket may actually be higher than at a out-of-network, fee-for-service provider.
Here are some other interesting articles about dental insurance:
ADA Morning Huddle: Public misunderstanding of dental insurance is widespread
The New York Times: I have Dental Insurance Why Do I Pay So Much for Care?
**The views and opinions expressed in this blog post are those of the author and do not necessarily reflect the views of any affiliated organization, association, company, or university.
