Q. Can you comment on dental insurance? I am a recent college graduate about to enter the workforce. Should I consider an employer offering health coverage including dental over one that does not? Do you have any experience in that area? — J.K.
A. An excellent question for all and especially for someone early into the workforce.
Dental insurance is not at all like medical. General medical insurance is so important to all when you consider the fact that no matter how you conduct yourself, medical problems can occur and costs for treatment may be out of your financial control. I believe that is why insurance is needed in many areas, but not so much in dentistry.
If you are to consider work for a company that offers benefits in many areas, assume nothing. You will have to meet with someone from the company, usually in the Human Resource area, who can explain all the ins and outs of supposed benefits.
Dental benefits are very different in that all coverage (that I am aware of) has what is called a “calendar year maximum.” Having a maximum protects the company from exposure to catastrophic dental claims. This way, the company is almost guaranteed to profit.
The benefit to you for dental coverage ranges from $1,000 to $2,000 per year. To get that benefit, you must first go to the dentist, have your teeth cleaned and examined. Almost all insurance companies will cover 80 to 100 percent of what they consider the “reasonable and customary fees.” That is the catch. In all my years in practice, no company ever asked me for a list of my fees. How does the company determine what is reasonable and customary? That is a good question.
My feeling is that the company keeps what they call “reasonable and customary” as low as they can. They then tell you or your employer that if, for example, $110 is what they consider normal and if your dentist charges $140, then your thought will be that your dentist is unreasonable. That is absolutely incorrrect. Your dentist is in control of his or her own business. Their fee schedule is determined by them and only them. They went into dentistry knowing full well that it is a health care endeavor as well as a business.
Let us be clear. The dentist starts his business as any one else does, puts in his or her intellect, his or her money and takes a chance that they will succeed in providing a quality care experience and at the same time earn enough money to take care of their needs. It is up to you to decide if your dentist charges a reasonable fee. The insurance company couldn’t care less. As we live in a capitalistic society, they are out to make money for their owners even if they are termed “nonprofits.”
As far as I have seen, the reasonable and customary fee that most companies say is correct has not changed in probably 20 years or more. Any patient should understand that costs for the practitioner have gone up exponentially in the last 20 years. Yet they are expected to still accept what the companies say is fair? Absurd. Only your dental professional can determine what that is. He or she decides what fees to charge. We live in a free society and the dentists need to earn a living as well. It is up to you to discuss the fee with your caregiver to determine if you think it is fair. Your relationship is with your dentist. They provide you with care and you provide them with the fee. The insurance company has nothing to do with it.
I believe the insurance companies got into the dental industry because they saw an easy way to make a great deal of money. I believe that there are many statistics to show that people with dental insurance use a very minimal amount of it. If their benefit is $2,000 per year, the insurance company banks on the fact that they will use less than $500 of it per year. And they are probably right. I believe they charge anywhere from $15 to $50 per month per calendar year.
If the employer or you were to take that money and place it in a separate account, my guess is that you will use about $300 per year. The rest you can save. This assumes that you practice good diet habits and good preventive dental habits. Discuss with your dentist how you can keep more of that savings in your account and not theirs. Yes, the dentist needs to make a living, but not at the cost of your getting disease. He or she, if a good ethical professional, wants you to avoid as much dental treatment as you can. Remember, the best dentistry is no dentistry.
— Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at [email protected].
https://ipswich.wickedlocal.com/news/20190314/nothing-but-tooth—-dental-insurance-is-not-like-medical-insurance
