DENTAL CARE

Q: A:

I have been asking my patients that question for decades. The answer really goes to the heart of the insurance industry and revolves around why we buy insurance. Insurance, whether life, disability or health care insurance all thrive due to the fear factor. We are all, and rightfully, so concerned about some event which will alter our way of life. This event usually has a financial impact upon us and our families. Along comes the insurance company and offers us a solution to the problem. They say: “Give us some money and we will take the uncertainty out of your future. You or your family will not have to worry about going down this road. We will take care of you.” We must remember that insurance companies are big business. They have two items on the agenda. First of all they have to be there when you need them. Secondly, they have to turn a profit like all businesses must do. In reach these goals, they create products based upon extensive data. They are much like going to Las Vegas. You can never beat the house. Of course, someone will win on occasion, but this does not usually make a dent in the overall picture. As in Vegas, there are usually more losers than winners in the insurance gamble.

However, despite this knowledge we still search for a product that will take care of us. We believe the sales pitch and buy the product. Our money is taken and we rarely see results. This is all a function of numbers and what is being paid for a premium. There are many ways for an insurance company to avoid paying for a dental procedure. This usually comes in the form of two clauses in the contract. The first clause is called the Alternate Benefit Clause. This is very common and is found almost universally. It states that if there is a less expensive way to do a treatment, that is all that they will cover. This is much like an adjuster on a car or house damage claim. The insurance company will adjust downwards the amount that you think that they should pay. Remember, what I mentioned earlier that insurance companies need to turn a large profit to stay in business. One such way is to limit the amount that they pay for a claim. That limitation has a direct impact on you. So, in a dental example, if you are missing teeth on both sides of your mouth and chose wisely to replace them, you will be limited in your choice of placement. The insurance company will only pay a portion (that’s another story) of a removeable partial denture even if you desire, and your doctor recommends, something permanent and not removeable. So now you have dutifully paid your premium and get pennies on the dollar in return for these monies that you gave them. Sure sounds like Vegas to me.

The next clause that we see often is a called a Missing Tooth Exclusion. This paragraph in your policy says that if you are missing teeth prior to going with this insurance company, there are no funds to improve your health with their help. They will not pay at all for your replacement teeth. This is true even if you and your doctor choose an inexpensive treatment. So with this clause, not only do they downgrade your benefits, they go even a step further. They refuse to pay anything towards improving your health. Almost all insurance companies will help you on cleanings and checkups. Only a handful will make a meaningful contribution to the real reason that you purchased dental insurance. I met a new patient yesterday who finally made up her mind to restore her mouth to a state of health. Some teeth were broken and a number were missing. Much to her surprise, because of the Alternate Benefit Clause and the Missing Tooth Exclusion, she had ZERO coverage for her desires. Just imagine her shock and amaze- Why Did I Buy Insurance If It Doesn’t Cover This Procedure? ment. Premiums paid but real benefits are not there.

So what does one do in order to accomplish needed dentistry. First of all find a dental office that really understands your insurance products and can guide and advise you if you do decide to purchase insurance. Better yet, I would suggest that you take the money that you would pay for premiums and put it in a special bank account to that you do not touch it. You are creating your own fund to handle unforeseen dental expenses. Lastly, find a dentist that you can work with financially. Payment plans and discounts make life easier and allows you to reach our goal of dental health. We are already in October. I want to help you reach your optimal dental health by time that the holidays roll around. Anyone who comes in and begins newly diagnosed treatment from now until the end of the November will receive an unlimited 20% discount. No treatment will be excluded. Rules do apply. Call Megan today at 440.951.7856 and schedule your appointment for the “Better Than Insurance” deal of the year.