What are your teeth worth? or How dental insurance can worsen your oral health.
Posted: March 23, 2014
Last Modified: June 6, 2022
Great! You got dental insurance! Now your dental dreams can be realized! Little do people know, but dental insurance can often be someone’s worst enemy in the pursuit of oral health. Explain how, you implore: how could the prospect of having someone else reimburse you for your dental work possibly be a bad thing? Isn’t a job with dental benefits (along with drug, vision, physio, the works) only going to get your mouth healthier? Don’t dentists love patients like you, who have benefits to pay for all that treatment?
Dental insurance is often a double-edged sword, and the aim of this post is to clarify how to get the best out of your insurance. We’ve written about it many times elsewhere on this site, but because this question / problem keeps popping up, it is important to remind people of its dangers.
Dental insurance messes with people’s heads. When a dentist recommends a course of action, it is because he/she sees a problem and is proposing either a fix for that problem or something that can prevent a problem. It is a recommendation based on your NEEDS. Now, when a dentist recommends something, often the next question becomes: “Is it covered by my insurance?”. A fair question to ask, and it’s great if it is, but what if it’s not? This is where the problems arrive – when a treatment is not covered by your insurance, that is all that it means: it is not covered by your insurance. It does not mean that the procedure is unnecessary, or excessive, or even cosmetic. It just happens that the policy that you possess does not cover that procedure. If you were to change employers, and the dental insurance policy changes, then you have a different amount of “coverage” for procedures – your mouth did not change, and your needs did not change. The only thing that changed is what your employer thought they would pay for when it came time to selecting a benefits package for their employees.
You know who doesn’t care about your dental insurance? Your teeth. They did not read the benefits manual that you got when you got this insurance. As a Barrie dentist, our job is to be an advocate for your mouth. Because your teeth cannot talk, we are the ones to talk for them. It’s up to you, the owner of the teeth, to listen.
Let’s illustrate the point a bit further, if you remain unconvinced:
There are certain procedures that are covered completely under most insurance plans, but some that are not. For instance, crowns are often covered at 50%. What does this mean? Does it mean that you only “need” half a crown? Does it mean that the insurance company only agrees with the dentist 50% of the way? Obviously not. The reason that some procedures are covered to a lesser degree is because the actuaries (and they are very smart guys) that insurance companies employ know that if they only cover a certain percentage of certain procedures, there will be a certain percentage of the population that will be unwilling to pay for the remainder. Instead of paying out 50% for that procedure, they end up paying out 0%. They have saved themselves that money that they were willing to pay out, and guess what? That money stays in their bank accounts.
Most dental plans have a yearly maximum dollar amount that will be paid out for each person under the plan. This means that no matter how much need you have, they will only pay out a certain amount. So, suppose we have a hypothetical person who has a mouthful of cavities because of bad heartburn. The stomach acid that makes its way into the mouth affects almost all the teeth. This person clearly needs plenty of dental work. Does it make sense to say that this person only needs the amount of dental work that is covered by his/her dental insurance and not $1 more? Obviously this is absurd, but we have more than a few people in our office who will tell us just that: they will only have procedures done in the mouth that are covered by insurance. Actual cavities go untreated.
So, the ultimate question is: what are your teeth worth to you? Dental insurance is unlikely to improve quickly. Sometimes the dental procedures a mouth requires does not fall within the terms of an insurance plan, and it is wise for you to take control of your own health by saying “I know it’s not covered, but teeth are important to me and I am willing to pay for them”.
If teeth are important to you, you are our kind of patient. If you would like a serious, comprehensive dental treatment plan that is heavy on prevention, contact us! We’d love to be your Barrie dentist.