Why did I buy dental insurance if it doesn’t cover this procedure?
Have you ever needed a dental procedure done only to find out your insurance doesn’t cover it? In dismay and frustration you ask the obvious question – ‘ What’s the point of dental insurance if it doesn’t cover this necessary procedure?’ I have been asking my patients that question for decades. The answer goes to the heart of the insurance industry and revolves around why we buy insurance.
Insurance companies prey on the uncertainty
Insurance, whether life, disability or health care insurance all thrive due to the fear factor. We are all, and rightfully so, concerned about some unseen event which will alter our way of life. This event usually has a financial impact on our families and us.
Along comes the insurance company and offers us a solution to the problem. They say: “Give us some money, and we will take the uncertainty out of your future. You or your family will not have to worry about going down this road. We will take care of you.”
Insurance companies are like Vegas casinos
We must remember that insurance companies are big business. They have two items on the agenda.
First of all, they have to be there when you need them.
Secondly, they have to turn a profit like all businesses must do.
To reach these goals, they create products based on extensive data. Much like going to Las Vegas, you can never beat the house. Of course, someone will win on occasion, but this does not usually make a dent in the overall picture. As in Vegas, there are more losers than winners in the insurance gamble.
However, despite this knowledge, we still search for a product that will cover us. We believe the sales pitch and buy the product. Insurance companies take our money, and we rarely see results. This is all a function of numbers and what is being paid for a premium.
Ways the insurance company avoid paying for your dental procedures
There are many ways for an insurance company to avoid paying for a dental procedure. Usually, it comes in the form of two clauses in the contract.
The Alternate Benefit Clause
The first is called the Alternate Benefit Clause. This exception is very common and is found almost universally. It states that if there is a less expensive way to do a treatment, that is all that they will cover. Much like an adjuster on a car or house damage claim. The insurance company will adjust downwards the amount that you think that they should pay.
Remember, what I mentioned earlier that insurance companies need to turn a substantial profit to stay in business. One such way is to limit the amount that they pay for a claim. That limitation has a direct impact on you.
So, in a dental example, if you are missing teeth on both sides of your mouth and chose wisely to replace them, you will be limited in your choice of placement. The insurance company will only pay a portion (that’s another story) of a removable partial denture even if you desire, and your doctor recommends, something permanent and not removable.
So now you have dutifully paid your premium and get pennies on the dollar in return for these monies that you gave them. Sure sounds like Vegas to me.
The Missing Tooth Exclusion
The next clause that we see often is a called a ‘Missing Tooth Exclusion’. This paragraph in your policy says that if you are missing teeth before going with this insurance company, there are no funds to improve your health with their help. They will not pay at all for your replacement teeth. This is true even if you and your doctor choose an inexpensive treatment. So with this clause, not only do they downgrade your benefits, they go even a step further. They refuse to pay anything towards improving your health.
Almost all insurance companies will help you on cleanings and checkups. Only a handful will make a meaningful contribution to the real reason that you purchased dental insurance.
I met a new patient yesterday who finally made up her mind to restore her mouth to a state of health. Some of her teeth were broken, and a number of them were missing. Much to her surprise, because of the Alternate Benefit Clause and the Missing Tooth Exclusion, she had ZERO coverage for her needs. Just imagine her shock and amazement. Premiums paid but real benefits are not there.
How to get the best dental coverage for your money
So what does one do to cover the expense of needed dentistry?
First of all, find a dental office that understands your insurance products and can guide and advise you if you do decide to purchase dental insurance.
Better yet, I would suggest that you take the money that you would pay for premiums and put it in a separate bank account so that you do not touch it. You are creating your own fund to handle unforeseen dental expenses.
Lastly, find a dentist that you can work with financially. Payment plans and discounts make life easier and allow you to reach our goal of dental health.
The “Better Than Insurance” deal of the year
We are already in October. I want to help you reach your optimal dental health by the time the holidays roll around.
To that end, we are offering the following “Better Than Insurance” Deal of the Year.
Anyone who comes in and begins a newly diagnosed treatment from now until the end of the November will receive an unlimited 20% discount. No procedure will be excluded. Rules do apply.
Call Megan today at 440.951.7856 and schedule your appointment for the “Better Than Insurance” deal of the year.
Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.More