Trick or Treat?
Insurance Companies Dictate, Delay, and Deny…
It’s a Trick for sure!
More about this trick below, but the main thing is every year hundreds of thousands of dollars of insurance money available to help people is kept by the insurance company as it goes unused and the ‘benefit’ lapses. Like cell phone companies used to get away with stealing when they charged you for minutes, insurance companies do a money grab at the end of every year and that time is coming up again! Make sure that any dental care you might benefit from is completed before the end of the year so you can utilize the money you are due – there’s still time, so use it or lose it!!
A little historical perspective on dental insurance… When insurance companies approached dentistry back in the 1960s, it seemed like such a good idea! At that time, it still seemed to be working for medicine and helped patients get the kind of care they needed even when they couldn’t afford it all at once… but like so many things, poor execution wrapped up in good intentions simply doesn’t pan out!
The whole idea of insurance dates back to the time of the spice trades when a ship would be lost at sea every year. A family only owned one or two ships so the loss would be catastrophic. As ‘insurance’ against this catastrophic loss, the families all pitched in enough money to replace the lost ship in case it was theirs, and every year this catastrophic loss was insured against. In the case of homeowners insurance and auto insurance, the catastrophic loss would be devastating to the family, so insurance guards against this. Even with medical insurance, the medical bills mount up so quickly that insurance can allow life-saving procedures to be completed and the insurance company evens out the burden by collecting from all their clients and paying a benefit out for only a few.
With vision and dental insurance, the annual premium isn’t much less than the annual ‘benefit’ and the insurance companies have developed several interesting or, perhaps devious, clauses and tactics to ensure they make money in the process. The reality is that while well-intended, dental insurance is simply a rebate program. The patient (or their employer) pays a premium every month and if they have the right kind of issue at the right time, the insurance company may pay some ‘benefit’ or rebate toward getting that care, but most max out at about $1,000 a year. When dental insurance was introduced, the annual max was about $1,000. That was the early 1960s… before we had seatbelts… before VCRs. Think about what $1,000 would by in the early ‘60s! The net result is rather than being actual insurance protecting you from catastrophic loss, dental insurance is simply a tool to help cover some expenses, and should those funds go unused every year, the insurance company gets to keep the money. Should you have a reason to have a significant amount of major dental work, they will only pay about $1,000.
They also have what’s called a UCR fee schedule – or commonly a Usual and Customary fee. This fee is proprietary and different for different companies and different plans within a company. They won’t publish it, and when they pay on this fee schedule, the UCR fee often ends being less than the lab fee of the restoration, and they only pay 50% of this made up fee!
Another alarming tactic is that when the procedure you and your doctor have agreed on and completed is submitted, the insurance claims person can ‘downgrade’ the treatment to the ‘lowest cost alternative’ treatment. This generally happens to be a mercury-silver filling that was introduced in dentistry in the late 1800s. Before we had seatbelts – or cars! At that time, our average life expectancy wasn’t even 50! Today, we live twice as long and it is simply irresponsible to place mercury-silver fillings in teeth today because we have vastly better solutions that don’t weaken the tooth and aren’t potentially toxic.
The reality is many people have insurance, and any financial support toward exceptional health care is a welcome thing! The key is to ensure that the insurance is helping and not hurting. Health care decisions made by an insurance agent or an MBA are generally made for reasons other than health care. As a patient, you have the right to decide what level of care you want. What is important to you? What level of health do you want in 5 years? In 15 years? Do you want to invest in excellent preventive care and keep your teeth for life? Do you want to invest in excellent dental care and eliminate migraine-type pain or chronic snoring issues and likely live a longer and healthier life? Today there are so many options and insights that there is no need to have removable teeth. It’s still an option, but it would be the lowest cost alternative.
Your dental healthcare team is here to help you achieve the level of care that is important to you. Your dental insurance is here to help you cover some of the costs involved in the care you want. If you have a benefit left to use this year, take advantage of those funds and take a step toward your health goals. Your dental insurance won’t cover all the costs of excellent dental care, but that money is yours so make sure you take advantage of it!
As a part of our commitment to helping you, we will always strive to maximize your insurance benefit or rebate. Our philosophy of care is to always be here to take care of you; to provide you with options for the best dental care possible, and to diagnose your mouth as we would our own. With that information, you can make the best care decisions for your health and your life. To that end, we made the ethical commitment to never diagnose to the standards of an insurance company, but rather to make the diagnosis based on what is best for you.
Have an amazing Fall and see you soon!