What’s the deal with dental insurance?

Posted .

Dental insurance is expensive. It is a benefit people pay for and only 20% of people use it.

My best description of a traditional indemnity plan is that you purchase a gift card for less than you will actually spend. Examples of this are spending $400 for $1000. Pretty good deal, right? Well, you can’t spend all of the $1000 on cleanings or whitening or veneers. They will give you a limit of how much you can use. Generally two cleanings a year and maybe some x-rays. They set limits on how much they will pay for these services based upon an arbitrary number called UCR (usual, customary, reasonable – which is anything but). This is an average of fees from a zip code. They will pay more for cleanings in San Francisco or New York City than they will in Locust Grove, Georgia.

This plan will usually allow you to choose your own dentist. The truth about dental insurance (or any insurance) company hopes is that you will pay your benefit and not use it. Insurance benefits were $1000 in 1960. The highest I have seen insurance pay in 2009 is $2000. So, not much progress in it. This is meant to help with basic care. Most of the costs associated with any insurance plan are to the support personnel to answer and administrate the claims made.

The next plan to describe is a HMO practice. This is where all of your benefits are prepaid by an employer to the dentist in order to take care of a list of people. They have very low out of pocket expenses. The model this type of clinic works upon is hoping to receive a check from the insurance company without having to treat any patients. This plan usually will not allow you to go anywhere other than the specific list of dentists who have chosen to discount their fees.

PPO, or preferred provider organizations is like having a Sam’s Club membership and a gift card. You can go to an out of network provider (like Publix to get milk) or an in network provider (Sam’s). You will be limited to your choices and will have to pay out of network fees but you are not held hostage like the HMO practices are.

Flex spending is the best plan I have seen. You can put money aside for whatever cosmetic dentistry you would like and use 100% of its value. They will pay for implant dentistry, sleep apnea devices, TMJ treatment.

Since insurance is so expensive and they will not really cover much, why use it at all? How is it beneficial? Families who have routine care going to the dentist generally will have to pay an average of $400 per year per person for cleaning, exams, x-rays and fluoride treatments. In the grand scheme of things, if this can be spread out throughout the year, it is extremely affordable. Diagnostic and prevention can save money in the long run so don’t wait until anything hurts. We can catch 90% of things early and SAVE You Money.

Come see us, insurance or not. We are a judgment free zone.