Give me a break. Dental insurance plans are a business arrangement between the insurance company and an employer. Unfortunately, the reimbursement and benefit levels are based on carrier and employer business decisions, and not on your need for treatment. At best, it pays for 2 cleanings and very little after that. Most plans have a maximum benefit of between $1,000 and $1,500 per year, which is a far cry from what you really need for your oral health care.
These benefits (I use that term loosely) haven’t changed since the 1980’s.[1] It’s ridiculous to tie your dental provider’s hands with reimbursements that haven’t risen in 35 years while the cost of living has increased dramatically in comparison. Patients that have major restorative or surgical needs or bite dysfunction cannot afford to delay treatment and spread it over multiple insurance plan years, because their condition may worsen if not treated immediately. And none of the reimbursements take into account the added costs of HIPAA, associated and new technologies.
Like medical insurance, some dental plans do not offer coverage for pre-existing conditions, such as missing teeth. This type of plan would not cover tooth replacement procedures, such as bridges, partial dentures, full dentures or dental implants. And the continued absence of tooth structure will result in the continued resorption of the jaw bone, further complicating the possibility of restoration.
Many insurance plans will unilaterally apply “alternate benefits” towards your service, such as paying for amalgam fillings rather than tooth-colored composite fillings, or, not covering major restorative services, such as a crowns, inlays, or Cad/Cam restorations.
Because insurance carriers are exempt from anti-trust laws, most dental plans use the terms ‘usual, customary and reasonable’ to determine your insurance benefits. This term applies to fee manipulation used by dental insurance carriers to set reimbursement levels across the country. The criteria upon which this research is based, including region, time intervals, type of dentist, etc., varies greatly from one insurance carrier to the other.
Unfortunately, under the current system there are very few dental insurance benefits that actually benefit you.
Novy Scheinfeld, DDS, PC
290 Carpenter Drive, 200A
Atlanta, GA 30328
404-256-3620
info@rightsmilecenter.com
[1] http://www.bls.gov/opub/mlr/cwc/dental-care-benefits-1995.pdf
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