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The Illusions and frustrations of Dental Insurance

Filed under: Insurance Brittany Speed @ 2:28 am

Are you frustrated with the illusions of your dental insurance benefits? You’re not alone!

According to a recent Gallup Poll study, only 45% of people with dental insurance benefits are actually satisfied with their insurance policy. And, many of our patients can completely relate. So, why are there so many illusions and frustrations with dental insurance?

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Insurance companies have the primary goal of being profitable, and employers are looking for the most economical way to provide employees with insurance benefits, and they may not even understand how much they are cutting the benefits to their employees until they are already in effect.

Illusions of dental insurance benefits

Google defines the term Illusion as “a thing that is likely to be wrongly perceived…” And unfortunately Dental Insurance benefits can easily be wrongly perceived, especially when big dental insurance companies have customer service representatives that are very well-trained (and recorded) to explain things in very specific, and often misleading and confusing terms.  Here are some of those illusions:

“Free Cleanings, X-rays and Exams”

One of the common confusions is the difference between what is “covered at 100%” and “free”.  When dental insurance companies say they will cover “100% of preventative dental cleanings, x-rays and exams” they usually add “subject to exclusions and limitations”

100% of what?? – Insurance companies typically do not explain that when they will cover 100% of any specific procedure, what they mean is that they will cover that percentage of their own list of fees for any given procedure, or their own “Fee Schedule”.  Their Fee Schedule is usually based on a reduction of what they call their “UCR” or Usual, Customary and Reasonable fee list, which is a list they make up themselves. A dental insurance company’s UCR is not related to an average fee in your community, it is strictly a dental insurance company derived fee schedule to determine their own level of payment. Here at Cornerstone, we have third party researched fee averages for our local community which we are happy to share if you are interested.

No regulations – Interestingly there are actually NO guidelines or standards that dental insurance companies are required to follow when they build their own list of fees for how much they will “allow” for any given procedure, including their “UCR” lists.  Most of these lists have increased very little over the past many decades, despite the increase in costs.

“Least Costly Alternative”

Cheapest Possible Alternative – Another common misunderstanding is that dental insurance companies will actually reduce their level of reimbursement to a “least costly alternative” or “least expensive alternative treatment” per their own determination. This means they not only make up their own fees, but they also opt to cover the lowest possible cost for any given alternative treatment option.  By paying for paying for only the least costly alternative the dental insurance company is essentially assuming your doctor’s role of prescribing for you according to a perceived “average” patient and are unaware of any particular problems, desires, or unique circumstances that may apply to you as an individual.  Are you average? Is it to your advantage to have treatment based on averages or would you prefer to have recommendations specific to you?  For example, a common item that we will see reduced is the cost of a filling.  A least costly alternative may be for the dental insurance to cover a lower allowance equal to what they would consider for the cost of amalgam (silver metal) fillings as opposed to resin or tooth colored fillings.  At Cornerstone Dental, we have never done a single amalgam filling since we opened our doors in 1988.

Annual Maximums

Rarely used – An annual maximum amount is one of the most commonly misunderstood aspects to dental insurance plans. A dental insurance annual maximum is just that, it is the maximum that a dental insurance policy will pay out in a given year, no matter what your expenses might be.  All of the standard things like waiting periods, deductibles, fee limitations, (see UCRs above) and percentages of coverage on any given procedure must all be satisfied before reimbursement is made. Our experience is that on the average, dental insurance covers about half of incurred expenses for major work, but even that is only up to their maximum annual payout.  For example, if your annual maximum benefit is $1000 you would likely need to have about $2000 of expenses to reach your maximum and it will pay no more than $1000 no matter how much your expense is above that figure.

What is a Dental Network?

Dental Insurance companies try to get dentists to agree to their financial arrangements and allowables through a contract.  If a dentist agrees to all of their contracted terms, they are considered “in-network” for the plans that are encompassed within their contract.  Dentists who do not agree to their contracted terms would be “out-of-network”.

In order to insure that you receive personalized recommendations and care Cornerstone Dental has opted not to sign a contract with any dental insurance company, making us “out-of-network” with any plan. As the patient you always have the option to choose an out-of-network doctor knowing that the reimbursement may be different than that for an in-network doctor.  Your dental plan should be able to inform you of what your benefits are for in-network vs. out-of-network providers.  If you have the option of seeing any dental provider you choose, there should be reasonable benefits for out-of-network providers.

Worth the Difference

We recently had a patient who is a business owner who had purchased a dental insurance benefit for himself and his employees.  He kindly called us and explained that he was sorry to leave after many years, but he wanted to have his records transferred over to another area dental provider that was in the network of their new dental plan.  However, a few weeks later he called us immediately after his first appointment there and scheduled his next appointment with us, returning to Cornerstone for his next cleaning and checkup 6 months down the line.  He said “I will never do that again.” He explained that he had been waiting in their lobby for over 20 minutes, and then in an exam room as he continued waiting for an additional 20 minutes before he saw the dentist.  He was extremely frustrated stating “The $40 that I saved was not even close to worth it for all the time I spent waiting.  I don’t care what the difference is with the insurance reimbursement, for me – it’s worth it to stay at Cornerstone Dental.”

No Insurance?  No Problem!

For many adults, the thought of being without insurance is terrifying.  We would never even dream of not having a current insurance policy for our car, or our home, etc.  However, the truth is – Dental Insurance plans are not like other insurance plans.  In fact, we have had a growing number of patients who have recently opted to cancel their traditional dental insurance coverage (especially self-insured and business owners) and opt to sign up for our Patient Loyalty Membership Program.  They have enjoyed a savings over what they were paying in their high annual policy premiums through our elegant and affordable solution which had no waiting period, no deductibles and no maximums.  Cornerstone Dental is pleased to offer this program that we began offering in 2013 to help our patients that don’t have insurance, and it has become quite popular.

We are happy to help

If you are frustrated with the illusions of your dental insurance, you are not alone.  Our practice coordinators are always glad to submit claims on your behalf to any dental insurance carrier, and we will always do our best to help you understand and maximize your dental benefits depending on your needs.  We are also happy to be able to offer an alternative through our Patient Loyalty Membership Program.

Committed to Excellence, Committed to You

At Cornerstone Dental, we have conscientiously decided to provide quality to all of our patients, and not allow dental insurance to dictate our materials, our equipment or the quality of service that we provide to our patients. The reality is that our patients are looking for quality and value, not just for the cheapest dentistry available.  We strive to assure that our fees are fair and reasonable while still allowing us to cover our costs and provide the excellence that our patients deserve. We have followed these principles since 1988, and generations of patients have been very happy with their dental results here at Cornerstone Dental.  If you have not yet been to our office, call us at 865-531-7117 and let us show you the Cornerstone Dental difference.