The first thing to understand about dental insurance comes as a surprise to most people- it isn’t insurance at all. Insurance is, by definition, a pooling of funds to pay for a rare, but catastrophic event. Examples include fire and flood insurance. Originally medical insurance was also designed this way. Over the years, medical insurance began offering payment for routine office visits, basic medications and low deductibles. These changes created additional employee benefits that are not true insurance, but “tax free” benefits.
Unlike cancer or a house fire, dental disease is neither rare nor catastrophic. Therefore, dental “insurance” is really a method for employees to receive “tax free benefits”. Rather than insurance it is more accurate to refer to them as dental benefit plans. When dental benefits were introduced in the 1970’s, these plans were simply designed and benefits were based on need. Over the years the costs associated with administering dental plans has risen resulting in higher premiums. The “benefits”, however, have become more restrictive and the maximum limit set in place in the 1970’s are the same today! Many employers are now providing “FLEX” plans where employees may commit pre-taxed dollars into a fund that may be used in lieu of dental benefits.
Limitations in coverage can take many forms. From simply excluding necessary services altogether to what the industry refers to as the “LEAT” clause, which stands for “least expensive alternative treatment”. This clause allows the company to choose to pay the cheapest alternative treatment that they consider adequate rather than newer, technologically superior services.
What does this all mean? Benefits were once determined based on need, they are now based on specific contract terms between an employer and the insurance carrier. In plans that direct you to specific dentists, there is also a contract containing specific agreements between the insurance company and the dentist.
At Dental Solutions, our only contract concerning your dental health is with you. We will perform a thorough, comprehensive exam to determine your needs. We are dedicated to helping you understand your current level of dental health, your treatment choices and the consequences of those choices. Once you have that information, you can choose what is best for you. Because our obligation is only to you, once you have made your treatment choices, there will be no compromise in rendering it.
Regardless of the type of plan you participate in, we still assist you with filing your claims. As your dental healthcare advocates, we will provide any documentation required to your dental plan so that you may receive the re-imbursement you are entitled to. We are however, powerless to influence plan benefits negotiated between your employer and the insurance company. Only you, through your employer or the benefits manager at your company can do this.
A common theme today when dental plans deny or reduce benefits is to imply that care is not needed or the fee charged is too high. We feel you are the best judge of your need, not a clerical person at your insurance company. Our response to the insurance company regarding fees is that their benefits are too low. Only you can determine if our fees match our quality.
Your insurance carrier doesn’t care if you keep your teeth… we do.
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