The Truth About Dental Insurance: What You Should Know (Part 1)

At Smile Fort Worth, our mission is to use our education and experience to help people achieve their best level of oral health. Unfortunately, we believe dental insurance companies are not set up to accomplish the same goal.

From insufficient coverage to long waiting periods to difficulties finding in-network providers patients feel comfortable with, there are a lot of problems with the dental insurance system that negatively impacts how people treat their oral health.

In this three-part blog post, we’ll take a deeper dive into the problems associated with insurance and explain why this so-called “benefit” is sometimes not-so-beneficial. 

Did You Know Dental Insurance Used to Be Good?

Believe it or not, dental insurance used to be a sound investment back in the day. Dental insurance was first introduced during the 1950s and plans rose in popularity during the 1960s. During the good old days, here’s what a typical insurance plan looked like:

  • It provided a reimbursement of about $1000
  • Covered 100% of all cleanings and check-ups
  • Paid for 80% of minor dental work (such as fillings and tooth extractions)
  • Covered 50% of major work (like crowns and dentures);
  • And didn’t distinguish between in-network and out-of-network providers.

These plans have drastically changed as boardroom executives discovered how profitable it is to reduce coverage while keeping prices the same (more on that in our second blog post). But here’s the most glaring aspect: these plans haven’t changed in 60 years to match inflation.

Most dental insurance plans still offer a fixed annual coverage amount of around $1000. In 1960, the average cost of a new car was approximately $2,600, while the average price tag today is well above $30,000. If dental policy maximums kept up with inflation, it would cover more than $9,000 of dental care per individual.

It doesn’t take a mathematician to see that the numbers just aren’t adding up.

Dental Insurance Pretends to Pay For Your Teeth

People pay for dental insurance because it’s sold to them as a bargain, or they’ve been conditioned to believe it’s something necessary to have before they even make an appointment. It’s marketing 101, and it’s one of the reasons insurance companies are so profitable.

In reality, dental insurance only pretends to pay for your teeth.

If you’ve ever researched dental insurance plans, you know that most policies cover the cost of a checkup. But, they don’t do so universally, and with many of those checkups, they’ll only cover the cost if you visit certain dentists. And if an unexpected emergency pops up, it will only cover it partially (or most likely, not at all).

Dental insurance shouldn’t even be called insurance, because it works more like a dollar-off coupon. Like we mentioned earlier, most plans offer a fixed dollar amount of around $1000, that you can use per year—and that’s it. If you reach the threshold of your coverage (which is easy to do if you need major dental treatments), you’re forced to pay out of pocket for the rest of the year.

You end up choosing an “in-network dentist” that you may or may not be comfortable with so that you can potentially get a slightly reduced price.

If dental insurance worked like most other types of beneficial insurance policies (like home and healthcare), it would cover the cost of unexpected problems AND allow you to go to a dentist of your choosing. 

Insurance Companies Shouldn't Control Treatment Plans. The Experts Should.

We perform or recommend treatments based on what we think is best for the long-term oral health of our patients. After all, we are the experts who underwent training and completed dental school. Sometimes insurance companies refuse to cover these treatments even if they’re necessary. Why should insurance executives in a boardroom dictate the care you receive?

Before we get into that, let’s unpack some common dental insurance claim problems for a second:

  • For procedures deemed “complex,” insurance will usually cover part of it (up to 70%).
  • Or more likely, if insurance deems it “elective” or “too expensive,” they will pay 0%.
  • So, what makes something “elective” or “too complex?” There aren’t any clear criteria for this, but it’s usually something the claims teams use in the rejection notice.

Time and time again, we’ve submitted claims to our patient’s insurance companies with ample amounts of evidence (like X-rays, photographs, periodontal charting, and treatment notes). And time and time again, we receive letters stating that they are denying the claim.

Here’s a story that really sticks out in our mind: once, we filed a claim that met the diagnostic criteria of the American Association of Periodontists—the organization that develops the best standards to treat gum disease. And to no one’s surprise, this claim was denied due to a technicality hidden in the fine print of the insurance contract.

The experts who quite literally write the book on gum disease would agree this patient needed treatment, but the insurance company didn’t. It’s incredible how one small string of words hindered this patient from receiving care that they severely needed.

Now for a moment, please consider this: no claims advisor from an insurance company has ever met or examined the patients that we see. Yet, somehow they get to pass judgment on what is and is not appropriate care. Does this make any sense?

At Smile Fort Worth, We Work For You. Not The Insurance Company

At Smile Fort Worth, we don’t treat your insurance, we treat you. We believe in practicing dentistry the way we were taught in dental school and delivering the best possible care to our patients. Our mission is to establish a relationship of trust with our patients, listen to their concerns carefully, and present you with the best options for your long-term oral health.

Check back with us for part 2 of this series. In it, we’ll examine the ways in which insurance companies are increasingly reducing coverage, and how standard waiting periods can have a negative impact on your oral health. 

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