THE TRUTH ABOUT DENTAL INSURANCE:
Dental Insurance should be viewed as a benefit of additional funds available for partial payment of your dental expenses. Years ago, dental insurance was a benefit which people could depend on to pay most of their dental expenses. However, with the deregulation of insurance companies, they no longer have your best interest at hand. They are more interested in their own prophets. Premiums keep increasing and the benefits keep decreasing as our government has let them take control of our health care industry thanks to lobbyists who subsidize our representatives to turn a blind eye on insurance regulation. This is not only happening with dental healthcare, but you can see the changes in medical healthcare as it becomes less personal and your access to physicians becomes less. You are more likely to see a PA or Nurse Practitioner since they are more cost effective to the insurance company than a doctor.
Insurance companies have come up with a term called “UCR” which means usual, customary and reasonable fee. This term is calculated at approximately 75-80% of the average dental fees for a given geographical area. The insurance company tries to make you believe that this is what the fee for service should be. They then pay 50 to 80 percent of that amount towards your services depending on the conditions in your plan. This translates to 40-60 cents on a dollar.
Dental insurance plans are a contract between you and your insurance provider made by your employer with the insurance carrier. There is no contract between the dentist and insurance company unless the dentist chooses to sign a contract to participate with them. A participating dentist signs off his right to charge the customary dental fees and agrees to follow their guidelines of treatment and accept the 40-60% payment reduction by the insurance company in return for patient referrals. This forces a participating dentist to use minimum quality materials and labs. This also limits their access to education and technology since they are forced to work within their budgeted guidelines. Insurance companies purposefully stay behind in advances in dentistry to avoid paying for new technology. They may also limit services they consider discretionary as white fillings, dental implants, bondings, fluoride treatments, and some periodontal (gum) therapies. In addition, dental coverage maximums have not kept up with the times. In 1960, a typical annual maximum benefit was $1000.00. These days, most plans still offer that same maximum of $1,000.00 despite the tremendous increase in premiums. To keep up with inflation, that maximum annual benefit should be $6,500.00 today.
HMO’s are even less conducive to good dental care. They are attractive to employers because they are less expensive. With HMO’s, the dentist gets paid a fee (ex. $20.00) for each participating patient per month whether they show up or not. He makes his money by hoping you don’t come in for treatment. He gets paid a small additional fee for larger services as crowns and dentures.
Chomiak Dental is committed to providing their patients the highest quality in dental care with the latest in materials, technology and techniques. Therefore, we have chosen not to participate with insurances although we accept most insurance plans. What does this mean to you? You will always be provided all available options. You can then decide which is best for you and your budget knowing that you are receiving the highest quality of care available. Some insurances will not pay a non-participating dentist directly so your initial out of pocket expense seems to be a little more. They market this as an incentive to visit a participating dentist. Insurance companies try to make it appear as though seeing a participating dentist is to your benefit. What they fail to explain is how their limited reimbursements to these participants inhibit even a good dentist from providing you with the quality care you deserve.
In order to offset this inconvenience that the insurance company has tried to create, our staff will immediately submit your insurance claim to make sure that you get the full reimbursement that your insurance company is required to pay. This money is returned to you usually within two weeks. Interest free payment options are also available to avoid up-front payments if desired.
Don’t expect your dental insurance to pay for all your dental work. It doesn’t work that way anymore. Although it no longer covers the full cost of your dental care, it is still a nice benefit to have assistance in covering your dental expenses. You should always know and consider your options when faced with dental choices. You should make decisions that are best for you, your budget and your dental health. Your insurance will be there to help in covering those expenses. Do not let your insurance make those decisions for you.
For those of you who are not provided dental insurance by your employer, we would not encourage any one to purchase independent dental plans. These generally cover very little and are set up to make the insurance company money. They are no longer managed to look out for the patient. We recommend setting aside the money which would be paid into a premium and saving it in an account in the event you require dental health care.