All Posts tagged dental insurance

The Pitfalls of Private Dental Insurance

Are you wasting money on 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!?

Whatchu talkin' about Willis?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

Are you covered?

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

Dental Benefits claim formBefore 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, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.


Why Dental Insurance is Typically a Bad Deal & What to do About it.

Dental Insurance policy denied

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.

Dental Insurance policy deniedWays 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.