Dental Insurance Explained

So, as I dentist I get a lot of questions about dental insurance. I am no insurance expert, but I would like people to understand it from the point of view of someone who sees it every day.

Dental insurance started in the 70's, with the maximum yearly benefit being about $1000. I am told that at the same time you could purchase a Ford Mustang for around $3000. I think everyone has an idea what a mustang would cost today, maybe $20000 to $30000. Now you would expect the insurance maximum to keep up accordingly, right. Well, the typical yearly maximum that we see is still around $1000.

You will hear insurance companies say that they cover something 100% or 50%. That can be a little misleading since the fine print will say that the percent coverage is a percentage of this "UCR". UCR (usual and customary) is an imaginary number that the insurance companies base their percentage that they cover. As you can imagine, the number is almost always always less, sometimes much less, than real fees that you would find if you surveyed dental offices. The insurance companies will not provide us the dental offices with these URC fees either.

So how do we figure how much they will actually cover, well we try to look at other instances that we have dealt with that particular company and what they paid. Or, we have to make the best estimate that we can. Either way we are estimating since they will not tell us exactly.

Another caveat of dental insurance is the "preferred provider". What this means is that they are "preferred" by the insurance company since that office has signed a contract with the insurance company. Why would the dentist do that? The dentist is then put on the list for the insurance company providers, so it is marketing. The insurance company requires the dentist to only charge fees according to a list that they are given. As you can imagine, the fees that the insurance company designates are substantially lower, sometimes 30to 40% lower than average dental fees. This sounds good for the patient, but sometimes the dental office has to make up for this loss in other ways, such as seeing more patients in shorter appointments. Ask yourself what you would do at your work if your employer wanted the same results, but asked you to take 40% less of your salary. We want our patients to have the highest quality dental treatment, so we take the time to provide all options and let the patient, not the insurance company, choose what is best for them.

So I don't want to paint a completely negative picture about In our office, we are glad to do everything that we can to maximize the patients benefits for they treatment they want.