By: Stephanie Smith, DMD

Lately, there has been a lot of press coverage given to “the right to healthcare”, to “ObamaCare”, but have you heard a word about dentistry?  What is dental insurance, and how does it affect your care? Dental insurance has become commonplace–almost as ubiquitous as major medical health coverage. While it is undeniably an asset when received as a benefit of employment, it is at the same time the product of a not-so-disinterested third party intent on maximizing its bottom line more for the benefit of its shareholders than its policyholders.      The intent of dental insurance is a different from that of most other types of insurance, in which the underwriting company assumes a small risk of catastrophic loss in return for a fee (premium). Catastrophic loss is usually not encountered in dentistry; it certainly is a risk in medicine. Medical insurance is protection against catastrophic but unexpected loss; dental insurance usually insures against small, expected loss.  Since dental insurance carriers must demonstrate to their shareholders that they can turn a profit, they hire actuaries to ensure that they take in premiums in excess of what they pay out in benefits. In effect, dental insurance inserts a middle man between the health care provider and the patient; this middle man will take his cut. The net effect is to increase the cost of health care delivery.
Let’s start at the beginning. Dental “insurance” had its beginning in the early 1970’s. It appeared that indemnity “insurance” would encourage those patients who needed or wanted dental treatment to have these services performed. Dental insurance acts a more of a reimbursement program, than true insurance. All plans have an annual maximum allowable benefit limit. All plans allow for certain procedures, and generally have contractual language that allows only for the least costly of all treatments. And then, only a percentage is paid. Significant limits are written into a contract that the dental patient rarely ever sees.
A dental insurance company will provide you with an “Explanation of Benefits” (or EOB) with the “usual and customary” fee schedule. This is a term coined by the insurance industry; it means little to policyholders, and less to members of the health care provider industry. It implies that it represents some statistical average of the going rate for a given service at a given locale at a given time. Do not be fooled by this linguistic trickery. The “usual and customary” fee schedules are simply based on actuarial analysis done by the insurance company.
Of course, most of the statistics were gathered during the 1960’s and those fee schedules have changed little over the last 40 years. In 1975, $2000.00 would provide a great deal of dentistry. It is important to remember that top-of-the line restorative dentistry included mercury silver fillings, and instruments were simply rinsed in the sink and soaked in some antiseptic. In more ways than one, times in dentistry have changed. But dental insurance has not.
As with so many benefits, there is more than meets the eye. The “insurance” industry was not satisfied with its influence on treatment plans and fee determinations. Eventually, a larger piece of the pie was requested by the industry in the form of “managed” care. This is where dentists who enlist, agree to reduce their fees by as much as 20% to have patients placed in their chairs. Managed cost, not managed care. Current American Dental Association data show that the average dental office overhead is over 70%. What type of care can those offices deliver given this arrangement? When a fee is reduced, where is that money made up? Materials?  Sterilization? Or, perhaps deliver of service. A hygienist cleaning the patients teeth, or an assistant placing a temporary filling, instead of the dentist. It’s definitely lose/lose/win for patient/dentist/”insurance” company.
Insurance is a profit-making business; the insurance companies do a claims utilization analysis to determine how much they must charge in premiums in order to make a profit. In other words, on average, the typical person paying for their own dental insurance will pay more in combined dental fees and dental insurance premiums than if they eliminates the middle man (who gets their cut) and pays dental fees directly.
If you do get it as an employee benefit, you seldom have much of a choice of policies; dental coverage is increasingly being considered an extravagance by employers–and the dental policies have changed the way fees schedules are agreed upon and how reimbursements are paid.
Most importantly, your freedom of choice is limited by a list of providers who are screened by no other means than a willingness to reduce the fees. These are the facts of dental “insurance”.
Drs. Stephanie and Kevin Smith founded Distinctive Dentistry of Chester County in 1990 to promote high quality, state-of-the-art dentistry to the discriminating patient. The doctors graduated from the world-renowned University of Pennsylvania School of Dental Medicine in 1987 and 1986 respectively. After working in a typical “family practice” where insurance policies were treated with more respect than patient care, Distinctive Dentistry of Chester County was opened. From the moment that you walk in the door at Distinctive Dentistry of Chester County you will realize that you are the most important person in the office and that this is a place where your needs come first. Whether you come to our practice for prevention, restorations that will leave your teeth looking naturally flawless, or esthetic dentistry for a smile of singular distinctive beauty, we want you to be glad you chose us to be your dentist.

Distinctive Dentistry of Chester County is conveniently located at the corner of Rts 926 and 202 in West Chester, PA.

Call 610-399-1080 today to schedule your consultation.
Check out our website at
www.ddofcc.com

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