The Pitfalls of Private Dental Insurance

Summer is in full swing, and the phones are ringing off the hook with patients looking to get their smile to look as good as their tans. Unfortunately, to offset the costs, many people will fall prey to the pitfalls of private dental insurance. Don’t be one of them!

Many people have gone out of their way to scour the internet or burrow into the brain of their insurance agent to find the best private dental insurance policy.
More and more ads are aired on TV with promises of saving a bundle of money.

If it’s too good to be true…

Those of us who have been around the block a few times know that if it sounds too good to be true, then it is probably is.
In fact, I’ll go even further. If it sounds too good to be true, it could even be bad for you.

How many times are we approached in an attempt to lure us into outstanding investments or cures that no one has ever thought of?

We are inundated, even more, we are bullied into buying into the fear factor that if we do not have dental insurance, we will not be able to weather the costs of needed dental care.

In the end, and sadly enough, patients who buy private dental insurance find out that they lack in their coverage.

While we’ve discussed and touched on this topic before, I want to go over some of the pitfalls of private dental insurance and why it is not a wise choice.

What Do You Mean that I Do not Have Coverage for A Whole Year!?

One big loophole for insurance companies is the elimination or waiting period.
You are not eligible for a variety of services that are in your “coverage” until you wait 6-18 months. This period varies by policy and company.

Let’s think about this.

You pay a premium month after month. Even worse, you pay a whole year premium up front and have no coverage. You need to fulfill your waiting or elimination period until your coverage kicks in

All the while, you are paying for coverage that you are not receiving when you need it.

That does not make any sense to me. It should not make any sense to you either.

Disappointment follows disappointment.

Okay so now we have paid our money and have fulfilled our waiting period. Our coverage begins. We plan our treatment plan together and find out another surprise. Your copay on more involved procedures can be as high as 80%. You have waited a year to find out that your coverage is only 20%.
Disappointment follows disappointment

Private dental insurance is not as comprehensive as you think

Wait! It gets better! Just keep reading.
When most of us think of insurance, we think comprehensive. It will handle anything that comes along.
While this is crucial, though not universal, in medical insurance, it is far from true in the dental field.

Every policy comes with a long list of exclusions. Sometimes an entire procedure or class of procedures is left out.

Crippled Coverage

Other times the procedure is crippled. What do I mean by crippled? Let me give you an example.

Let’s say that you need a filling on a back tooth. A vast majority of doctors will do a white filling. This is in demand by most patients and can help strengthen the tooth via its bonding mechanism. So we call the insurance company to find out rules and parameters. They tell us that a filling is covered, but white fillings are excluded. Silver fillings are part of the policy and nothing more.
If we need to step it up a bit for structural reasons and do an inlay, which is a solid filling, there is no coverage.

These are just a couple of examples of crippled coverage.
Insurance companies call it an “alternate benefit clause.” It is part of every insurance policy. It is loaded and quite common in privately purchased policies.

So now our 20% coverage that I mentioned above has been reduced even further by the crippling techniques,

So you tell me. Is it worth your money to become part of this system?

The premium that you pay may give you a cleaning or exam, but falls so short on the items that you may need or want.

Let us examine your policy before I examine your teeth

Before you pay your premium, I recommend that my patients bring in the information about the policy.

I look it over, and Megan calls to get all of the details. I can then advise you on what may or may not make sense for your needs.

If it works, then I will encourage you to buy it. If it does not make financial sense, then I can provide you with a paper shredder for your hard earned money.

This is because you are just throwing your money after an elusive cloud that just floats away from you.
You can never grasp it or genuinely benefit from it.

Even if you are not a current patient, I will be more than happy to advise and help you avoid the pitfalls of private dental insurance.

Please call me at 440.951.7856 and ask to speak to me. I look forward to talking with you.

Jeffrey Gross, DDSFAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

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