7.29.16 Issue #751 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Belle DuCharme, CDPMA
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Untold Truth - Insurance Companies Hate Dental Policies
By Belle DuCharme, CDPMA

My opinion, based on filing dental claims since 1973, is that dental insurance is not profitable for insurance companies unless they charge premiums that are far more than the covered maximum benefit for the period of the policy. 

Most people use their dental insurance for two hygiene cleanings, an examination and x-rays. After those procedures are completed the usage often goes down, as out-of-pocket costs outweigh the perception of benefit. Yes, even for fillings. But if the patient paid for the two cleanings, exam and x-rays out-of-pocket, they could negotiate and probably get the services for about the same as the policy costs the patient or employer.

Let’s face it, the insurance company needs profits to survive, so they are betting on keeping what is left of the $1,000 maximum because the patient opted to not use the benefit. It would make more sense if employers gave employees $1,000 worth of dental benefits a year and forgot about the dental insurance entirely. For those of you who don’t know, in 1973 the typical dental benefit was $1,000 and it paid for a lot of dentistry. We all know that $1,000 doesn’t cover much dentistry today.

Working for offices and filing claims for years tells me that dental coverage is terrible, and not so much from the percentages allowed but more for the low dollar benefit and the policy limitations. It is bad enough that only 1,000 benefit dollars are allowed per calendar year (average), but to further limit this dollar amount by contract/policy exclusions and limitations is absurd. It isn’t the insurance company’s fault that they want to make money by not spending it, but it leaves the patient without necessary care and with less than good health. For decades I have expounded upon the “myth of dental insurance” to my patients, only to be told they would “wait till it breaks” before taking a proactive approach to dental health care without dental insurance.

Many uninsured people postpone dental care because they don’t have coverage. The problem is, neglect of the mouth is accumulative. After several years of neglect, the cost to get the mouth in a healthy state again is never going to be covered by any typical dental insurance policy. On average, the cost to get anywhere close to fixing the neglected mouth will be about $10,000. The cost for dental insurance premiums would be far too expensive for employers to offer to their employees along with the costs for medical coverage.

I have witnessed patients coming in for care after years of neglect, not because they seek health, but because they finally have a dental policy. Most of these policies have a 12-month wait period before major services are provided because the insurance companies know the benefit dollars will quickly be used up. In many policies there is the detrimental “missing tooth clause” that in the dental world is the same as a “pre-existing condition” in the medical world. This clause is on many dental policies and it states that unless the policy was in place at the time the tooth was lost or extracted, there will be no benefit paid to replace the missing tooth or teeth.  

The truth is, everyone will need a dentist at some point in their life. As long as dental insurance is offered by employers or made affordable by the ACA it is part of the culture and environment of the typical dental practice. It is not difficult to maximize the patient’s dental plan for the calendar year, especially with the years of neglect, but what is difficult is knowing how to negotiate the world of reimbursement to make sure the dentist is paid for services provided, and ensure the patient is benefitted by quality care to improve their health. 

The world of dental reimbursement is getting more complicated, and now many patients are showing up with embedded or bundled policies that include their medical coverage and dental together. It is vitally important to be knowledgeable in this area of dental insurance benefits.

To learn the latest about dental insurance filing and reimbursement techniques, call McKenzie Management for a course in Advanced Business Management today.

If you would like more information on McKenzie Management’sTraining Programs  to improve the performance of your team, email training@mckenziemgmt.com

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