I have been in dentistry for 18 years now, practising in both the US and Canada, and I have watched the changes in dental insurance and the effects on patient care. Dental insurance was first sold in the 1970’s; however, the average maximum allotment provided by most insurance carriers, according to the Dental Wellness Center, remains at $1,500 per year, an amount that has not increased since the 1970s. Inflation alone would have increased that amount to $10,000. This continually limits the amount of coverage provided by insurance plans and prevents dental offices from covering their increasing overhead costs.
In 2012, patients want the most modern and up-to-date equipment, techniques, and technology used in dental care, and they should get it! The costs of providing this type of care are astronomically higher than they ever have been, but many practitioners feel limited in their ability to offer the highest-quality of services for the minimum benefits patients receive from their dental insurance.
In the province of Ontario where I practice dentistry, the Ontario Dental Association publishes a yearly Fee Guide which includes codes utilized by dental insurance companies to categorize treatment for the purpose of deciding what benefit to pay to patients. Dental offices are instructed to use this document as a “guide” only, and strongly suggests setting our fees individually. Our office, like many others in North America, charges fees higher than the guide suggests, and we feel our fees reflect the high level of service and treatments we provide, as well as our ongoing team commitment to continuing education. The insurance companies, however, would prefer if patients believed that every single dentist is exactly the same, provides the same service with the same technology and expertise…which cannot be possible!
In our office, we always recommend the treatment that will best benefit each individual patient, regardless of insurance benefit or lack thereof. Patients should understand that the insurance companies do not have a patient’s health in mind when determining reimbursements; insurance companies are businesses, and their business thrives when THEY DO NOT PAY! When patients ask us if they should pay out of their pocket for dental insurance, we recommend that they calculate the yearly expense for doing so, the yearly benefit the insurance will reimburse per family member, and a “likely assessment” of their dental needs each calendar year. For a family of five (2 parents, 3 children) an insurance plan could help cover the cost of regular dental exams, dental cleaning, xrays, and some basic fillings each year. However, what that means to a family of five is that there will still be out-of-pocket expense incurred because the insurance will not likely reimburse 100% of the cost! This fact is most important when considering dental treatment needs for an adult dental patient aged 40+, or one who has had lots of dental treatment over the years, as the costs of ongoing treatment will likely exceed yearly benefits with possible root canals, crowns, dental implants, etc.
It is best to ask your dentist (or us!) about your specific plan benefits, because most benefit plan information books can be difficult to understand for the layperson. For small business owners, sometimes the best type of plan is a Health Spending Account. It’s a great way to receive a greater tax benefit even without dental insurance. It works for any type of medical or dental expense. And if you have regular dental insurance which only reimburses for a part of the treatment, all receipts can be saved and used towards taxes at the end of the year!