Thursday, September 15, 2016

Do you take my dental insurance? Nope and Here is Why!

Lately, I have been thinking a lot about the dental insurance industry and the public's expectations of it.  I am not a participating provider in any plans. 

Why, you ask?  Please read on.  

The definition of insurance: a practice or arrangement by which a company or government agency provides a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium.

The key phrase with this definition is: "guarantee of compensation".  

Some examples:

If my home burns down, gets damaged by hail, or ruined by a flood, I expect that my homeowner's insurance will compensate me to rebuild my house and help to replace my belongings. Of course, after I pay my deductible.  I don't expect my homeowner's insurance to pay for my replacing air filters for the heater. I don't expect them to pay for caulking of my shower on a regular basis. I don't expect them to pay for the blowing out of my sprinklers or cleaning my air-ducts. 

If I get into a car accident, I expect that my auto insurance will compensate me to fix or replace my car and help with any injuries as a result of the accident. Again, after I pay my deductible.  I don't expect them to pay for my oil changes, my brakes, rotating of my tires or other preventative measures that I would take on a regular basis to keep the car running smoothly and safely. 

If I get sick, I expect my health insurance to cover for my medical bills after my deductible is met. I trust that my physician knows what is best specifically for the treatment of my medical problem and recommends things in my best interest.  I don't expect my plan to pay for my health club membership, healthy organic eating choices, vitamins or anything that would help me be more healthy proactively.  

Now let's look at dental insurance -

A typical dental insurance plan will pay a certain amount per year for your dental treatment in the range of $1,000-$2,500.  They pay a percentage of the procedures done and fix costs that your dentist can charge for these procedures.  In some states, they control the prices for procedures that they do not cover, but that is another story for another time. There may be a deductible to pay as well as the monthly premiums.  

Let's base these scenarios on the dental insurance model - 

If my home burns down, my insurance pays me $1,500 and I am responsible for paying everything else to rebuild my home, I am responsible for replacing my possessions lost in the fire.  There may or may not be a deductible. They may ask for a pre-estimate of the worth of my home and possessions but that but burned up in the fire and delay the payment accordingly.  Even though the maximum amount they will pay is $1,500.  Oh by the way, your deductible is $1,000... They don't care that you have been doing regular maintenance around the home on a regular basis.  They will question the use of certain pressure fire hoses to put out the fire saying that a garden hose would have been sufficient. Or they may have down-coded the use of a fire truck to a typical water pail passing line that was used in the 1,800's.   

If I get into a car accident, my insurance pays me $1,500 according to my plan, and I am responsible for the remainder of the damage, paying for any injuries, etc. Typically there is a deductible of $2  50-$1,000. I find out that they only pay for 50% to replace my tires.  They won't tell me 50% of what however.  I choose the same tires that I had on the car and they proceed to say that I was overcharged at the tire store that they recommended I go to.   I find myself questioning what benefit I am getting here as I add up my monthly premiums and the payout in my head...."Is this really worth the hassle?"

If I get sick and in the hospital, my insurance pays me my $1,500 while I am responsible for any blood work, x-rays, MRI's, surgeries, medications, ongoing therapies, etc....deductible? As an aside, I ask my physician how much each of these tests she is recommending are going to cost.  Blank stare...After an uncomfortable 60 seconds of silence I burst out, "Doc, I need to know how much this is going to cost me!"  She replies, "I don't know, I can have my office manager check what your benefits are and get back to you tomorrow"  

In any of these alternate scenarios, my financial responsibility would be catastrophic. 

Dental insurance is a misnomer.

It is not insurance.  It is a pre-paid benefit plan. It is in fact the opposite of insurance.  It covers the deductible and you cover the rest.

I think dental insurance is great for basic dentistry - cleanings, check-ups, x-rays, a filling here or there, etc.  If things get complicated with your treatment, your benefits will cover only what they cover based on the plan and nothing more.

What the benefit company isn't telling you - "We are great for basic dental care but don't expect us to be like homeowner's, auto or medical insurance.  Those insurance models cover you to prevent catastrophic loss.  We don't...Please set your expectations accordingly."

I choose to have a relationship based practice.  I take the time to get to know my patients and help them to discover and achieve their oral health goals.  Together my patients and I look at all the options with the pro's and con's of each.  Most of my patients have dental benefits and we do everything to help maximize those benefits for our patients.

As a result, I choose not to participate with these benefit plans.  I wish to have a relationship primarily with my patients.  A relationship that is not tethered by the restraints put on by an insurance company that has never met their subscribers. You are a number to them, a potential for them to pay out against their profits.  I view the relationship that I have with my patients as the most important aspect of my practice. I will only recommend treatment that is in my patient's best interest in achieving their goals for their teeth and smile.

By the way, if you don't have dental insurance, basic dentistry is fairly affordable and the cost of prevention is much cheaper than the cost of complicated dentistry caused by missing regular dental checkups!

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website or like our facebook page,  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK