Can we have an honest conversation about dental insurance?
Is dental insurance a good value? It depends on each individual situation and dental health status. There seems to be a sweet spot – if you only need two cleanings, digital x-rays and one exam per year or if you need quite a bit of treatment, you aren’t in it. If you take advantage of the regular cleanings, digital x-rays, exam and need just one crown—you’ve found the sweet spot!
The reason we say this is because dental insurance works opposite of the way health insurance works. With health insurance you have a maximum out of pocket each year. With dental insurance they have a maximum out of pocket each year. Dental insurance companies usually only provide a maximum of $1000-$1500 of coverage per year, leaving the rest of the expense to the patient. That maximum amount covers 1 crown – that’s it! So, if you need more treatment than that one crown, it’s on you!
Let’s look at the numbers – Patient cost w/ insurance: Annual Premiums $228-$384 (Group Plan)
$0 Preventive Services (2 cleanings, x-rays, exam) 20-50% of non-preventive treatment
100% above $1000-$1500
Minimum out of pocket: $228-$384
The high price of being a Network Provider:
To be a network provider a dentist must agree to provide services at a discounted rate. Not only that, but the insurance company will only pay for certain alternate types of services, not necessarily what is best for the patient. This down-grading of treatment is often the most frustrating part for a conscientious dentist. In this case it’s a win for the insurance company because they get to pay the least amount possible and the patient must either choose to accept the down-graded treatment or the optimal treatment and pay the difference out of pocket.
Not only is optimal care a concern for your dentist, but there is a practical side as well. The financial side to operating a business. We’ve heard com-ments from people who believe dentists make a lot of money.
Maybe some do, but most dental practices have a 60-80% overhead expense. In our case it’s at the 80% because of the high-end dentistry we choose to provide.
We choose to use the best quality dental labs and materials. We choose to invest in the best equipment and technology available. We choose to educate our staff in the latest techniques and provide them a better than average wage and benefit package. All of this so we can provide our patients the best care and treatment options available in an environment that is safe and comfortable. The result is less money lining your dentist’s pockets, but they can sleep well with the choices they’ve made.
When Dr. Mark and Dr. Nick started their dental practice in the 1970’s the maximum annual dental insurance coverage was $1000 on average. Inflation has increased by 625.8% since then but the insurance companies haven’t increased the coverage at all so your $1000 actually covers significantly less than it did. If the insurance companies adjusted for inflation your coverage should be $6258 per calendar year.
This inflation rate equally affects the cost of doing dentistry. Every year the cost of dental supplies, office supplies, oxygen and nitrous, anesthetic drugs, utilities, employee wages and benefits, etc. has continued to increase however, the dental insurance companies do not keep pace with the reimbursement rates to the dentist. For example, the reimbursement rate from Delta Dental for a basic cleaning has remained the same since 2010, scaling and root planing has remained the same since 2008. Every year we request an increase in the reimbursement but they decline to accommodate. Essentially, this is comparable to working without a raise for 7-9 years, meanwhile your rent, groceries, utilities and gas for your car have all gone up. You would feel the pinch wouldn’t you?
It’s no wonder some dentists are forced to make the tough decision to use lower quality dental labs and supplies, skip the staff training, not hire the most qualified employees. It’s a matter of making ends meet. We will continue to choose the best whenever and wherever possible because we believe our patients deserve it!