June 28, 2011

More to Know About Dental Insurance

     The benefits you can receive from your insurance program are dependent on the amount your employer pays the insurance company.  In order to make a profit, the insurance company must pay out less in benefits than they collect in premium.  To limit their expenses, the insurance industry has created various restrictions which have nothing to do with your individual needs or health such as:
  1. An annual limit.  Regardless of the treatment you need, they only pay so much per person per year.
  2. Excluded treatment.  Regardless of the treatment you need, certain things are not covered like cosmetic work or in most cases, dental implants.
  3. Fee limitations.  Regardless of the specifics of your case, only so much may be paid for any particular treatment.
  4. Frequency limitations.  Regardless of what you might need, they will pay for a procedure only so often.  An example is a dental cleaning which may be “payable only twice a year” regardless of your gum condition that may require cleanings three or four times a year.
  5. Procedural limitations.  Regardless of what treatment might be best for you, they may only pay for the least expensive treatment possible.  For example, they might only pay for a removable bridge when a fixed bridge would be better or they might only pay for a filling when a cap is clearly a better choice for your tooth.
  6.  Time limitations.  Regardless of when you want to do the treatment, they may request that you notify them in advance of your intended treatment.  They cannot require you to get a pre-estimate prior to treatment as a condition to paying you your benefits.  They will always pay you what you are entitled to.  As a matter of fact, our experience has often shown that pre-estimates prior to treatment are actually more likely to stimulate a rejection of coverage.

     Please remember that while it is nice to have the insurance program pay for as much of your treatment as possible, and finances are sometimes a consideration, your decisions on what treatment you choose are best based on your own best dental health interests.

     For more information on other dental topics, please visit DrTav.com

June 15, 2011

Some Important Information If You Have Dental Insurance

     While many people have dental insurance, very few understand what it does and how it works, or what rules it has and why these rules exist.  This information will help you understand your insurance better.  We think it’s important that you understand that your dental insurance isn’t dental insurance at all.

     Dental insurance is unlike any other type of insurance and so insurance companies have developed some unique policies.  We think once you have this information much of the confusion you might have about dental insurance will be cleared up.

     In general, insurance has four requirements:
  1. We want to protect something specific against loss.  Things we insure are our house, our car, even our life.
  2. The loss must be undesirable and infrequent.  No one wants to have their house burn down, have their car stolen, or a gall bladder infection requiring surgery.  The insurance company can count on you trying to prevent the loss.
  3. The occurrence of loss must be unpredictable on an individual basis, but statistically predictable on a group basis.  In other words, you never know if or when you might have a car accident or need your gall bladder removed, but the insurance company can predict that out of every 100,000 people a certain percent are likely to have their car damaged or need an operation in a given year.
  4. The cost of the loss must be individually predictable and the risk known in advance.  The premium charged by the insurance company is based on this.  For example, if you want to insure a 1991 Ford Mustang that costs $16,000, the insurance company knows what it usually costs to fix or replace the car.  The risk of loss is known in advance.  The premium can therefore be calculated in advance on an individual basis.

     Dental insurance is actually entirely different because:
  1. Dental disease is not specific.  It could be decay, gum disease, broken or chipped teeth.  It could even be crooked teeth that one person may want to fix and another might not want to fix.
  2. Most people do have dental disease.  Cavities and gum problems are extremely common despite the fact that people don’t want them.
  3. Dental treatment needs vary from person to person based on things like how often people go to the dentist.  People may even choose to go to a dentist more often when they have insurance.  People who get medical insurance do not decide to get their appendix out to take advantage of their new insurance.
  4. The dental insurance is contracted on a group basis by a company for its employees.  No one really knows the dental needs of any one person or the potential risk (cost to repair the dental problems).

     You can see that dental insurance really doesn’t satisfy the requirements of insurance at all because dental disease is not specific, not infrequent, not unpredictable in occurrence, and not predictable in cost.  Dental insurance really is a program established by your employer to give you an extra benefit of employment and not really insurance at all.

     Our next blog will discuss the restrictions the insurance industry has created which have nothing to do with your individual needs or health.

     For more information on other dental topics, please visit DrTav.com.