Understanding Dental Insurance...
and How It Works.

Dental insurance has become a highly complex product that creates confusion for many dental patients. The complexities of dental insurance and the lack of sufficient information provided by some insurance companies make it almost impossible for some patients to properly understand their benefits. Even more confusing is understanding how to properly work with your dental insurance company to achieve the highest level of benefits to which you are entitled. Dental insurance is a contract between your employer (or you) and a dental insurance company. The benefits that you receive are based on the terms of the contract that were negotiated between your employer (or you) and the dental insurance company. Dental offices have no involvement in determining which dental services are covered or the percentage of the fee that is covered. The goal of most dental insurance policies is to provide benefits for only basic dental services. The services selected are based on the cost of the policy to your employer (or you) and the negotiated arrangements with the dental insurance company. Usually, the least involved, lower fee, dental services are covered at a higher rate than the more involved, higher fee, dental services and select services (cosmetic dentistry, implants, TMJ, occlusion or bite redesign) are not covered at all. The selection of non-covered services is not based on what you need or want, but strictly on the contract between your employer (or you) and the insurance company. Dental insurance policies also have a limited maximum annual dollar amount that they will reimburse to you, the beneficiary. Once this limit is reached, the insurance company will not provide additional coverage for any dental service until the renewal date, regardless of how essential the service may be.


And Now Managed Care Too?

To add to the complexity of traditional “indemnity” dental insurance, now add the layer of managed care on top of that. In a tradition of dentist-patient relationship, a patient selects a dentist based upon reputation and need. The patient makes a decision whether or not to stay with his selected dental practice. The practice handles the responsibility of submitting insurance forms to the insurance company and patients are responsible for paying the amount not covered by the insurer. Managed Care is a concept in which patients have very little say. Under managed care, insurer’s contract with dentists who agree to discount their fees in exchange for a volume of patients enrolled in the insurer’s specific plans, usually by their employers. Patients are then either assigned to one dentist or told to choose from the insurer’s list of contracted dentists. Patients have nothing more to say about selecting their own dentist. If the doctor you currently visit is not on the Insurer’s list of contracted dentists for that particular managed care plan, that plan will typically not pay for the service you receive or will pay at a greatly reduced rate. The overall goal of “managed care” is containment of healthcare costs. It is true that managed care plans have helped reduce the cost of health insurance premiums to employers. Certainly, by discouraging doctors from performing costly procedures, costs are reduced. However, the focus has shifted from the patient’s well being to the bottom line and patients lose the freedom to choose their dental care. Managed care essentially forces patients to see dentists who have agreed to accept lower fees in exchange for a greater volume of work.


What Does This All Mean To Me, The Patient?

As a result, the traditional doctor-patient relationship has been replaced by the doctor-insurance company-patient relationship. In this 3-way relationship, instead of subsidizing the care of patients, dental insurers are now dictating who patients will see and what type of care they will receive by contract. It is not unusual for insurance companies’ employees (non-dentists) to dictate the type of care that is acceptable for patients. The pressure on dentists, under this type of arrangement where they are under contract to reduce fees and defer treatment approval to insurance company employees and patients are there not because they chose to be there but because the insurance company has essentially shoveled them there, is to see as many patients in as little time as possible or to sell services not covered by the insurance plan at hyper inflated fees to try to make up the loss in income- it can’t be managed otherwise. Keep in mind that your long-term health and comfort is NOT the goal of insurance companies. The insurance industry is a for-profit only industry. Most insurance companies are public entities who are obligated to show a profit and pay dividends to shareholders of their stock-in direct conflict of interest with paying benefits (reimbursement for healthcare expenses) to policy holders. Your doctor took and is bound ethically by the Hippocratic Oath which says “I will follow that method of treatment which, according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous.” Insurance companies are not bound by any such ethic on behalf of the patient.


What is Comprehensive Dentistry of Orange Beach’s Position?

Assuming you have the read the previous sections on dental insurance, managed care and their effect on the dentist-patient relationship, we want you to know that we resist any product that adversely interferes with a healthy, wholesome doctor-patient relationship. That means that we remain committed to excellence in the quality of care that we provide to our patients and in prevention of dental diseases. We are committed to being proficient in and providing a wide range of dental services at fair fees to anyone. We refuse to play games with the insurance industry or the public by having tiered fee schedules (some hyper inflated) for different groups. We are not opposed to dental insurance, just to how the insurance industry designs and promotes some products.


How Do I Get the Most Bang for My Dental Insurance Buck?

Insurance was designed to offset potentially catastrophic financial loss from unexpected occurrences such as natural disaster, vehicular accident, liability, illness or even early death. It should not be viewed as a means to finance dental treatment. Dental insurance is very limited in coverage to begin with and catastrophic dental expenses would rarely exceed the price of an automobile. Ask yourself, “Would I finance my automobile with auto insurance?” Of course each individual should weigh his own risk of potential occurrence against his ability to reserve funds to pay expenses in the event of an anticipated occurrence. Then ask yourself if dental insurance is worth the cost. Of course, if you anticipate dental problems because you neglect your dental health, we don’t think the answer is dental insurance. The old adage, “an ounce of prevention is worth a pound of cure” certainly applies to dental health and associated expenses. Dental care is not expensive when considered over the long term and in comparison to other common expenditures. For instance, the National Bureau of Statistics reports that in 2008 Americans spent 3 times as much on hair care, twice as much on cigarettes and 1.5 times as much on credit card interest as on dental care. This comparison seems to suggest that dental expenditures are more a matter of priority. Of course, sometimes there are old failed dental restorations that, when restored, could place a temporary strain on finances but there are much more effective ways to plan for and finance such occurrences than by relying on dental insurance. For instance, taking a tax deduction for every dollar spent on dental care through a qualified Health Savings Account can equate to up to a 30% discount on dental services. We work with Care Credit finance which provides up to 12 months interest free* to the patient line of credit for such instances where personal finances would be temporarily strained. We believe that healthy comfortable beautiful dentition is an investment that pays overall health and social dividends every hour of every day, unlike the depreciating value of an automobile. We are committed to your dental health and will help you get the most out of your investment.