House Call - 2017

Is My Dental Insurance Really “Insurance”?

By Vatsal Suthar

Every year, more than a million people go to emergency rooms with dental problems, which often turn out to be a cavity causing a toothache. It's not like they've had a car accident, but the kind of problem you could treat in a dental office. Since few hospitals want to pay to keep a dentist or oral surgeon on hand, a prescription and a referral back to their dentist is the only “treatment." These visits end up costing our health care system more than a billion dollars a year where the problem wasn't solved for the patient and infection spreads.

Earlier this year in February, a young father in Utah died after an infection in his tooth went to his lungs. Vadim Anatoliyevich, 26, waited two weeks before he saw a dentist about a neglected toothache. It takes months for a cavity to develop on the outer shell of teeth but once it gets through to the nerve, the symptoms of pain signal that treatment is required quickly.

If enough time passes, the tooth pain goes away and can cause you to believe the problem has too; this is not true. The nerve inside the tooth has died and now the bacteria have moved onto the jawbone to wreak more infectious havoc. This pain can take another few months to come back—if you are lucky. By following the recommendation of getting a dental exam twice a year, almost every condition (cavities, gum disease, sinus issues, oral cancer) can be caught early and treated before it becomes costlier, time consuming or even fatal.

Health insurance companies have plans for everything including dental but it's all separate. These powerful companies, that have millionaire CEOs, know that having a separate policy for medical and dental will make them more money. On top of that, selling policies in mass quantities to big employers like our state government, Amazon, or DAK can yield massive profit.

Dental work and oral hygiene programs were always on a pay-for-service basis until 1954 when California introduced the first actual dental insurance plans. They became more popular and more widespread during the 1960s. What became known as Delta Dental Plans began the concept of pre-payment. As these plans became more widely available during the 1970s, the maximum annual coverage was about $1000.

Fast forward 50 years to our modern world and a lot has changed. The maximum annual coverage of a thousand bucks, however, has not. A person in 1970 could get a lot of dentistry done for a thousand dollars but that could get you a couple fillings in 2017. Why has the cost of dentistry gone up so much? Greedy dentists wanting to fund their fancy cars, vacations, and luxurious lifestyle? Not exactly.

The evolution of government organizations, programs and laws like OSHA, FDA, Department of Labor, HIPAA laws, the IRS, Medicare, American Disability Act, and now Affordable Care Act, have all caused the cost to run and operate an independent health care facility to skyrocket. On top of this, the costs to implement and update technology like computers, dental equipment, x-ray machines is a never-ending hamster wheel of bills.

Even if you are lucky enough to have an employer offer a dental plan that offers a thousand bucks worth of treatment, you'd want to sign up to take advantage right? Get a detailed copy of your policy to review all the obstacles that the insurance companies have set up for them not to pay for any dental treatment: co-pays, age restrictions, exam frequency rules, waiting periods, no coverage, clauses that state it won't replace missing teeth, and the list goes on for dozens of pages in the policy manual. Insurance companies are smart and know how to make money by using tactics like this. So many layers of red tape and delays by an insurance company to pay out on claims is why only 5% of policies ever reach their max.

A common misconception is that you have to have dental insurance to see a dentist. This is absolutely false. Paying for preventive services like cleanings, exams, and x-rays out of pocket can come out to be the same price as paying for a dental insurance policy you have deducted from your pay. If you have $25 come out your paycheck every two weeks, that's $650 dollars a year. Any dental office in the Southeast will charge less than that if you are looking to only take advantage of preventive services.

Many dental offices are beginning to offer an in-house membership program or discount plan to the uninsured patient. Depending on how it is set up by the office, a person with no dental insurance can pay a monthly or yearly fee to receive a discount off the cost of treatment with that dentist. This helps a person get the treatment they want without the middle layer of a dental insurance company trying to hinder treatment with a mountain of rules all in their quest to post more profit for their shareholders. Many dentistry owners are willing to give senior, cash, and prepay discounts.

Dental insurance, in many ways, is a misnomer. Traditional insurance in any other industry is designed to protect you for worst case scenarios: auto collision, house fire, and death. Dental insurance plans do nothing to help if you fell and broke your front tooth and needed a replacement. Instead, dental benefits are designed like a glorified coupon and store gift card. You get a little discount for using in network providers but you only have a certain amount they will cover before they expire at the end of the year.

So if you want a $3000 big screen TV but you only have a $1000 gift card, you will have to pay the remaining balance after using the card. If you don't want to pay anything out of pocket, you will likely need to settle for a less expensive, smaller, off brand TV.