Dear Patient: Five Things I’d Like You To Know About Your Insurance

Dental insurance can be a huge asset in making dental treatment feasible for a patient. Unfortunately, patients are less likely to understand their dental insurance benefits than their medical. While medical insurance covers most or all of the necessary procedures with only an initial deductible or minor co-payments, dental insurance operates off of a very low annual maximum that is often insufficient to cover the patient’s dental needs.

Why is this important to talk about? Almost every day I talk to a patient who has avoided the dentist for 5, 10, or even 15 years because of a lapse in dental insurance. These patients are often the ones that excitedly return for a cleaning and exam thinking they can finally bring their mouth back to health now that they have a new insurance plan. Unfortunately, these are also the patients that usually present with multiple dental problems and extensive treatment needs.

When these patients are handed a treatment plan costing several thousands of dollars for root canals, crowns, restorations, etc., and only the first thousand of it is covered by insurance, it’s like a punch in the gut. This can lead to some pretty tough emotions—denial, anger, even depression. The dental office is often the heel of the anger and depression. So patients, here are a few things I’d love to explain to you about your insurance benefits.

1. Your insurance company is a business. A well-run business makes more money than it spends.

In the insurance company’s ideal world, everyone would just have dentures. That way, your employer would still provide insurance, but no one would need any procedures. The insurance provider would continue to collect money, and you wouldn’t use any of your benefits.

Keep your teeth! They are wonderful, beautiful teeth. Just make sure to make regular appointments so we can keep them that way.

2. Just because your insurance doesn’t cover it, doesn’t mean you don’t need it.

I understand that your insurance company covers the amalgam restoration at 100% and the composite restoration has a co-pay, but pleeeeease give me a few seconds of your time to explain the differences between the two. There are benefits to treatment options that are not covered, or not covered fully, that I’d like you to understand before you make a decision about your dental health. When you lock yourself into the mentality that you must stay within your benefits and annual maximum, you can avoid necessary treatment and create a snowball effect of future, more expensive dental problems.

Dental insurance is made to cover tune-ups and oil changes for your mouth with the occasional tire rotation. Sometimes the engine or alternator goes, and you have to dip into your pocket a little deeper than you’d prefer.

3. The negotiated rates we are accepting from your insurance provider often barely cover our costs.

I know dental procedures can be expensive. It gets me down when my patients think the money from those procedures goes directly into my wallet. Patients are less likely to let me know when their tooth hurts or schedule an appointment when they know a tooth needs treatment.

I know I can seem pretty glamorous with my white coat and all, but I promise I’m not ordering procedures to get my hands on your money. After I sterilize the instruments I’m going to use, have the room disinfected and set up for your appointment, take the time to calm your fears and get you comfortable before starting, administer anesthetic, complete the procedure, give you post-op instructions and explain your prescriptions (all while paying an assistant, front desk staff, and the electric and rent to provide you with the space to accomplish all of this), the profit margin is far lower than you might think.

When the economy goes south, finances more easily trigger patients’ emotions. We get that. We try to keep our costs at the lowest level possible while still providing you with the highest quality dental work.

4. A good dentist won’t plan treatment with your insurance coverage in mind.

If I did, I would be forced to misdiagnose, under-diagnose, and recommend inappropriate treatment options. I became a dentist to provide excellent care to my patients, not to be at the mercy of a company who could care less about my patients. I’ll do everything I can to allow you to maximize your insurance benefits, but I can’t alter your treatment needs based on your insurance plan.

5. Our office is not in cahoots with your insurance company.

I can’t begin to tell you how much easier our office would run if we didn’t deal with them at all. We work with them on your behalf, and only for your convenience and benefit. We aren’t holding late night meetings with your provider figuring out how to nickel and dime you from both ends. In fact, most of our encounters with them are explaining why they should pay for something they are trying not to.

Those are five things that will make your life easier as you try to fit dental work into your budget. I hope you will find them useful and they will lead you to happy teeth!

Courtney Lavigne, DMD