Many of our patients ask us “Which Dental Insurance plan do we recommend?” They are under the assumption that dental insurance will pay for all of their necessary dental health care. If that was the case, it would be like either car insurance or medical insurance, and the price of your dental insurance would vary based upon your age, your current health condition, what you need, any prior existing conditions, and give you the option to purchase extra coverage for cosmetic options.
Unfortunately, they don’t operate that way. If you are able to qualify for some type of large group plan, that often “spreads out the risk” among the members (since some people NEVER go to the dentist!). On the other hand, these plans are often chosen by your company’s HR department for you. They often make their decisions based upon the overall cost to the company and the budget they allow for it. Most of these types of plans will cover preventative and basic treatment (cleanings, exams, fillings, x-rays) at a higher rate, and then major treatment (crowns, implants, dentures, etc.) would be covered at a lower percentage. This means, if you are on a strong maintenance program, you won’t need to utilize your insurance maximum. However, if you need comprehensive care because of years of neglect or poor home care, you will receive a maximum amount each year and then you are on your own.
Whether a plan pays 90% for “in-network” dentists up to $1,000 per year or 60% for “out-of-network” dentists up to $1,000 per year, you will still need to pay out of pocket for anything over $1,000 in one year! They purposefully try to confuse and mislead the subscribers into thinking they are getting a deal because they pay a higher rate. The truth is, “A dental insurance plan cannot afford to stay in business if it pays out more than it brings in from premiums!” This means it is more appropriate to call them “Dental Benefits”, rather than “Insurance Plans”.
We have worked with dozens of dental plans over the years. We have decided that we are your DENTIST, not the insurance company. When we diagnose your health care needs, it is based upon what is best for you, not what is covered by your insurance plan. If you broke both your arms, you wouldn’t want us to wait until next year to have one broken arm put in a cast if your plan only covered one broken arm a year! But the truth is, that is the mentality that insurance companies subscribe to for their coverage plans!
So, how do insurance companies make their money? They offer higher deductibles, extend out replacement periods, have waiting periods for larger treatments, limit the procedures they will pay for, and put maximums on annual payment amounts. Over the years, we have seen Dental Plans shift from premium plans to Preferred Provider Plans to Dental Health Maintenance Organizations. As this happens, the benefit amount allowed goes down and the reimbursement to the dentist goes down and the quality of care often has to go down as well. Many of the plans being offered now reimburse for a dental cleaning at a rate less than the hourly rate we pay our hygienists! What this means is that those offices that are heavily into DHMO plans end up having to cut corners somewhere. It can mean shorter appointments, less time in between patients, longer waiting periods for patients to be seen, and the level of personalized care starts to deteriorate.
At Deltona Smiles, we are committed to providing our patients the BEST care possible. We will only provide the care that we would offer to our own families. In fact, our staff and families are patients at our practice because of that! You deserve the best care when it comes to your health!
We have provided a few tips to help you maximize your dental plans:
If you have an HMO plan, see if your company will allow you to switch over to a PPO plan, they typically won’t limit you as much on which provider you can go to, and they often have higher annual benefits.
Start your treatment earlier in the calendar year, so that you can maximize your benefits available instead of walking in the week before Christmas hoping to get $2,000 worth of work done.
Recognize and understand your policy before you start any treatment. Know that if you have been to another office or if you see a specialist, that could affect your maximum payments each year.
We have found that in many cases, for individuals who self-insure (buy an individual plan), it ends up costing them about the same or in some cases even MORE in annual premium payments by the time we include co-payments. You are basically paying an insurance company to manage your money for you. The admin fees for dental plans often eat up 35% of your premium!
At DELTONA SMILES, we will do our best to help you maximize your dental benefits if you have insurance plans.