The credit for this blog article must go to Dr. Mac Lee (no, he's not related), of Edna, Texas. I've made some important changes to this article for the Australian market; the States and Australia have a very similar experience, otherwise.
Dental Insurance: What??
20 years ago, dental “insurance” benefits averaged $1,000 which was the equivalent of around $1,600 today. Here is the kicker; the average “insurance” plan is still close to $1,000. The purpose of this article is to explain the facts and fiction of what everyone calls dental insurance.
Fiction:
You have a house fire and your homeowner’s insurance steps up to the plate and lets you rebuild and replace the stuff you lost. You'd think the same thing would happen with dental "insurance": you come down with a bunch of tooth problems and the insurance company gets you all repaired.
Unfortunately, that's big time FICTION.
Fact:
People who think they have “dental insurance” really only have LIMITED AND RESTRICTED benefits that are CONTROLLED by an insurance company. A dental benefit is more like a coupon. It doesn’t pay for the entire product or service, it only pays a certain percentage and it has a maximum it will pay.
Fiction:
“My dental insurance will pay for it!” or “My dental insurance will pay 80 percent!”
Fact:
A $1,000 was a reasonable amount of money when I graduated from dental school in 1992. My crown fees were around $600 and insurance could, would and did pay from 50 to 80 percent. Basically, a patient could get two or three crowns a year on old broken down, filled teeth and in a few years, their mouth was fixed. Plus, the patient could get two cleanings a year and not even max out their insurance. I can’t speak for the insurance companies or the patients that paid the premiums, but it was a great deal for patients and dentists.
Today’s crown price for one tooth will basically wipe out a year’s benefit. Not only that, the insurance company (yep, the one with the tallest buildings in all major cities around the World) often goes out of its way to DENY your "benefits".
Fact:
Today’s dentistry is nothing like it was 20 years ago. If patients had problems, the choices were to pull, fill or crown. Today’s dentistry serves the patients with some the most advanced, pain free techniques in medicine. Most of these procedures are not covered by the dental benefit contract or the procedures cost more than the paltry yearly benefit.
Twenty years ago, there was no such thing as Member Preferred Dentist. Today’s insurance companies want you to choose a dentist based on cost and assume that all doctors are equally talented, knowledgeable, caring, ethical, available and personable—and that just isn’t true. The dentist making the deal with the insurance company may take a cut up to 30 to 50 percent. In order for them to stay in business, they have to see more people, do more procedures and cut costs in some manner. And even though it is a managed care system, dental benefits still acts as a coupon and not insurance.
Fiction:
The dentist and dental team should understand a person’s dental insurance benefit, what it will cover, pay etc.
Fact:
The contract is between the patient and insurance company. The dentist has no role to play whatsoever; they are simply caught in the middle. Dentists, as a whole, are great people who love to help others. They try very hard to accommodate by hiring extra staff just to handle the paperwork, phone calls, etc that insurance companies require.
MOST IMPORTANT: NEVER LET THAT IMPERSONAL INSURANCE COMPANY DICTATE YOUR DENTAL CARE. THEY COULD CARE LESS ABOUT YOUR HEALTH, COMFORT, PEACE OF MIND OR APPEARANCE. Be happy you have that coupon for some "dollars off", but never expect them to rebuild your burned-down house.
Thanks again to Dr. Mac Lee, for "tellin' it like it is"! This article had so many "a-ha!" moments, I just had to share it.
BLOG OUT...
