A Few Thoughts on Dental Insurance

Most people have dental insurance because it’s provided as an option through their employer, and it’s usually a good idea to sign up for that benefit. In fact, dental insurance purchased individually is usually not cost effective, but covered through a group employment plan can be very beneficial.

Most policies are set up like this: the employer negotiates the details of the policy and pays most of the premium, and the employee chooses to join the plan paying a small portion of the premium, or to not join the plan paying no premium and receiving no benefits. The employer dictates what dental procedures are covered and not covered, which dentist you can see, what percentages will be paid and how much of an annual maximum you’ll be allowed to spend (more on that later).

There are as many different dental plans as there are different employers. Even plans from the same insurance carrier are different from one employer to the next. For example, some plans cover routine dental teeth cleanings

twice a year at 100% reimbursement; others will only pay if you get the routine cleaning done at a dentist on their “list” (the “list” includes dentists who have agreed to accept a certain fee schedule); still others will only pay 90% or 80% of whatever they determine to be an acceptable fee. Some plans pay for two cleanings a year, others pay for one every six months – this may seem like the same thing until you dig a little further. The twice a year policy will pay for a cleaning done in January and another one done in February, but then not again until January of the next year. The once every six months policy will pay for a cleaning on January 10, but they will not pay for the next cleaning until July 11 of that same year (a cleaning done July 9 is not six months after the January 10 cleaning and therefore will not be covered). Of course this last example assumes the year begins January 1 and ends December 31, but even this is not universal.

One way employers save money is in the way they determine Usual, Customary or Reasonable (UCR). Usually, they buy a policy that pays 70% to 90% of what all dentists in the area charge. For example, if most dentists charge $200 for a procedure, the employer can choose a plan that pays $220 for that procedure. However, to save money, the employer can choose a plan that only pays $180 for that procedure and the insurance company will report to the employee that their dentist’s fee was above the Usual, Customary and Reasonable fee for that procedure. Naturally, the patient will assume the dentist charged too much, but in fact the employer simply chose a plan with a lower reimbursement rate so the employer can pay lower premiums.

Another major factor is that dental insurance stops paying after an annual maximum has been reached. Unlike regular health insurance that pays 100% of everything (up to one or two million dollars, usually) after your deductible and out of pocket maximum has been reached, dental insurance stops paying after they have paid a predetermined maximum, typical $1500 but it can vary from $1000 to $2500. Once again, the employer determines this amount based on how it affects the cost of their premiums.

What’s important to keep in mind here is that all these things are done for cost reasons rather than dental health reasons. The employer wants to save money on their premiums, the insurance company wants to save money of their claim payments. The health of your teeth is left up to you and your dentist. It’s true that having a regular teeth cleaning and check up will maintain good oral health, which is a part of your overall health, and many dental plans encourage regular cleanings; however, one can never loose sight of the fact that the employer and insurance company will never see the inside of you mouth and will never make decisions based on what’s best for you.

Dr. Greenwood is on two insurance company “lists.” Both companies have multiple plans, some he’s on and some he’s not on, so you’ll have to check with your particular plan to see if he’s on your “list.” The two companies are Delta Dental and BlueCross BlueShield. The majority of our patients have other dental coverage, most of which consider Dr. Greenwood’s fees as Usual, Customary and Reasonable. We accept ALL dental insurance, but in a few cases they’ll be a difference between what the insurance pays and what Dr. Greenwood charges. The patient is expected to pay that difference (unless other arrangements have been made). The only insurance that will not work in this office is the one where the patient MUST go to a dentist on the “list” (these plans are rare because they are so restrictive). However, the real value in coming the Dr. Greenwood is in the honest approach he takes toward the ultimate goal of a healthy oral cavity for his patients. He rarely thinks ALL of someone’s fillings need to be replaced; if a filling will work instead of a crown, he’ll tell you that; but most importantly, he gives you options in your treatment clearly explaining the pros and cons of each option allowing you to choose what works best for your situation.