|Thank you for coming back as a reader on this confusing but important subject. What I would like to accomplish with this writing is a more complete understanding of how the present dental insurance system works.
You must understand that not all dental insurance companies treat their policyholders the same. In fact, some do a good service for the patient/policyholder compared to other dental insurance companies. You will notice that it will seem like I could use a lot more pronouns and abbreviations, and I run the risk of boring the reader with detail. I want to be precise and leave no doubt about what I am saying.
I will be discussing the dental insurance system in America, and why it is a very inefficient way to deliver dental care. I invite anyone who disagrees with me to please respond publicly. Perhaps you are aware of facts I haven’t encountered. I’m sure the News’s Journal will welcome your perspective on this issue.
I’m going to try to be brief, but detailed enough to support my assertions. If you would like further information about anything I say, please visit our web site @ DrCroner.com or e-mail me your questions at DocCroner@verizon.net. If you want a response, please leave your telephone number. I cannot type, and I don’t send e-mails.
So here we go with 12 things you should know about dental insurance.
#1: Dental insurance is not insurance, it is a defined benefit. Insurance is something you buy to protect yourself against unforeseen circumstances. Dental insurance can be used for unforeseen circumstances, but typically has a configuration of preventative services and treatments to avoid those unfortunate circumstances. Dental insurance is provided as part of an employers benefit package to its employees. The employer and employee usually share the cost of the insurance premium. They pay the insurance company.
#2: Not all dental insurance plans are alike. In fact, employees in the same business may have separate plans with each plan having different services and costs to the employee. In my experience, many dental insurance policyholders from different employers think their insurance is the same and covers a lot more services than it does.
#3: Dental insurance companies are bottom line driven. Their number one priority is to make money. Money to pay their staff and executives, pay for their state of the art headquarters and field offices, pay the stockholders dividends, pay their marketing and advertising, pay their lobbyist and lobbying expenses. What’s leftover is used to cover a limited amount of dental services for the policyholder.
#4: Dental insurance companies work for the policyholder. The employer pays part of the premium as a benefit to the employee for their labor. The employee pays the rest of the premium. The entity that receives the money from the employer and employee is the dental insurance company. In exchange for the money, the dental insurance company provides assistance in helping the policyholder receive dental services at a better value than the policyholder could have received if they sought those services on their own. At least that is what the insurance marketing department is peddling.
#5: Dental insurance companies do not care about the quality of the dental treatment that the policyholder receives. I, nor any other dentist I know, nor am I aware of any published instance, of a dental insurance company monitoring or even inquiring about the quality of dental treatment that I provide. I am not a preferred provider in any network, but have been treating patients with dental insurance since the inception of dental insurance. When I am solicited to join a preferred provider network, never has the quality of the care that I would provide been discussed.
#6: Dental insurance companies do not care about a patient/policyholders long term dental health. It’s a routine practice of dental insurance companies to pay only for the cheapest adequate care even when the cheapest adequate is not in the patient/policyholder’s best health interest. It is routine for an insurance company to deny a proposed or completed treatment or to reimburse the policyholder at a rate of a cheaper adequate procedure.
#7: Dental insurance companies provide poor support services for their policyholders. It is typically up to the business staff at the dental office to explain the details of a dental plan to the policyholder. It is the dental office staff, by virtue of their hands on experience with dental insurance and their assessability to the policyholder that make them by default the representative of the insurance. It is a long frustrating, and often futile effort by the policyholder and the dental office staff to talk to a dental insurance representative who can answer and solve the policyholders concerns. It routinely takes a month to get the answer from an insurance company about whether a dental treatment will be covered by the insurance and at what rate.
#8: Dental insurance companies often make mistakes about the policyholder’s coverage. When they make the mistake, with the exception of one time that I am aware of, it is always in the insurance companies favor. Whether it is by design or unintentional the insurance company always benefits by their own mistakes.
#9: The harder the dental insurance company makes it for the policyholder to understand, and receive their payments, the longer they keep the policyholders money. The longer they have the policyholder’s money the more money they make. It is not uncommon for a policy holder to become so frustrated in attempting to collect their reimbursement from the insurance company that they just give up trying to collect.
#10: Dental insurance companies pit dentists against the policyholder. They do this by making the dentist‘s office the unofficial representative of the insurance company. When the policyholder has questions or complaints and wants answers, there’s no dental insurance service representative to whom they can talk. Therefore, they conveniently contact the dental office. Often the dentist office is the first one to explain to the policyholder the unexpected limitations of their treatment coverage. This can be shocking and infuriating to the policyholder. Often the dental office is just as confused about their coverage, and frustrated by the process to getting answers from their insurance company.
The insurance industry also has a secret process they use to determine what fee they believe a treatment is worth. They don’t and will not reveal how this fee is determined. If they receive a bill for a treatment that exceeds their secret fee, they pay at their fee rate with the explanation that the dentist fee exceeds the “usual and customary” fee. There is no usual and customary fee in private dental practice. In fact, it is unlawful for private dental practices to set a standard fee because that is ‘price fixing’ per the Federal Trade Commission.
#11: Dental insurance companies are playing hard ball to pressure private practicing dentist
to join their preferred provider network. Their most recent attempt has been the issue of assignment of benefits. Refer to my first article last week for an explanation of this issue. What can be equally as important to the policyholder as the convenience and reduction in their out of pocket expense, is also the ‘Explanation of Benefits’ (EOB), that accompanies reimbursement check directly to the dentist. An ‘EOB’ is documentation of what the insurance company has paid, and at what rate, but also what they are not paying and for what reason. When the dentist office reviews the check and the ‘EOB’, they can check for insurance company errors and explanations on any changes in payment that the insurance company has made, thus, protecting the patient. If the check and ‘EOB’ get sent instead to the patient, they often don’t know what they are being reimbursed for and if there are any mistakes. This makes it even more difficult for the dental practice to keep track of what the insurance company is paying for and maintaining a good relationship with the policyholder.
#12: An out-of-network private practitioner dentist works for the patient and works for their
best interests. An in network preferred provider works for the dental insurance company and for their best interests.
In summary, the dental insurance industry is not a cost effective system. It provides poor customer service and discourages optimum dental treatment potential. It can be very profitable to the insurance company. The dental insurance business sells their services to provide better dental care to the policyholder. In reality, they sell only poor service.
Next week, I will describe an already available and utilized alternative to dental insurance. It is cost effective, simple to understand and service and can contribute to optimum dental treatment.