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DENTAL INSURANCE IS NOT GOOD FOR PATIENTS by Franson KS Tom, MS, DMD.

Dental Insurance is not insurance.  Patient think dental insurance covers everything like medical insurance and are surprised at how much they have to pay out of pocket.  Whether a dentist is a provider for your insurance or not, every dentist tries to maximize your benefits, but it is the dental insurance company who determines what is covered and your benefit, not the dentist.  The list of services covered under third party dental insurance are Uncaring, Convoluted, Restricted (UCR) Fees that make oral health care inappropriate, and unaffordable to the sick patient, caring doctor, and your employer. Dental Insurance knows exactly what they are doing.  Third Party Dental Insurers deliberately write one-sided, complex, detailed contracts that they know no one understands especially the patient, the doctor, and the employer.   They know it does not cover services patients really need for good oral health.  They know it is the least expensive contract for themselves that creates the most profit for themselves.  They know they falsely blame the doctors for the shortcomings of their inadequate coverage.  They know if they make it uncaring, convoluted, restricted, inappropriate, and unaffordable for patients that few dentists will provide services.  They know that fewer dentists means more profit for themselves. Is that the kind of care you bargained for with dental insurance?  If not, then dental insurance is not good for you.

Dental Insurance is called a third party because they deliberately interfere with the patient-doctor relationship that should be a two party relationship of trust like it has been for centuries before dental insurance.  A patient comes to a doctor for necessary care and the patient with their doctor decide what is best for the patient’s oral health to look good, feel good, and work good.  Dental Insurance is Uncaring because they don’t care about your oral health needs.  They care about their company profits.  The services they cover are temporary alternatives at best and not the kind of dentistry you or your doctor would prefer or expect.  Dental Insurance is Convoluted because no patient could possibly complete any dental insurance claim form with all it’s constantly changing codes, rules, policies, benefits, and reimbursements that still takes months to collect.  “Prior Authorization” is the most convoluted, misleading practice by dental insurance.  “Prior Authorization” has nothing to do with the diagnosis, the treatment plan, the need for treatment, the skill or quality of the dentist.  If “Prior Authorization” had anything to do with these things, why are only the most expensive procedures ever need prior authorization?  Shouldn’t they prior authorize every procedure?  After 1, 5, 10, 20 years of prior authorization, hasn’t the dentist proven they don’t need prior authorization?  “Prior Authorization” has everything to do with third party profits.  The third party is checking if they pay, will they make a profit.  If no profit, then it is rejected.  The third party may give many reasons why it is rejected, but never for their true reason...obscene third party profits.  Third parties even go further to make it falsely appear that it is the dentist’s fault i.e. greed even though the dentist is required to discount their fees 30-50% to treat third party patients.  However, every rejection for payment of promised patient benefits is the decision of Dental Insurance, not your dentist.  The dentist may be the messenger who informs you that you still owe for services you agreed to do, but please do not kill the messenger.  Your battle is with Dental Insurance, not the dentist.  The dentist is trying to balance an affordable fee with a reasonable profit, so that they can continue to provide the affordable dental care you need for good oral health.  Dental Insurance is Restricted to a very limited list of services at an artificially low percentage of reimbursement with a maximum benefit set and unchanged since the 1960’s. The only thing that has increased 150% every decade is dental insurance premiums.  This has made dental insurance unaffordable for your employer.  Instead of covering “everything”, dental insurance barely covers simple procedures that may prevent problems if you already in ideal oral health.  If you are not in ideal oral health, dental insurance covers very little.  Is that the kind of care you bargained for with dental insurance?  If not, then dental insurance is not good for you.

Dental Insurance is not even cost efficient.  The average premium costs $600 to $1000/year.  If you work 20 years, you paid $12,000 to $20,000 in premiums.  The average premium payer only receives $250 benefit/year.  If they see their dentist every year and pays their share of the bill that is usually about $250/year.  Over 20 years of employment, you will average $5000 benefit if you paid $5000.  That also means you are paying at least 140% ($350) profit/year/premium payer for $250 benefit each year after you pay $250.  The dental insurer makes $7000 on each premium payer even if they don’t increase the premium for 20 years.  We already know dental insurers increase premiums 150% every decade.  Even though a premium payer is promised up to $1000/year, less than 5% of premium payers ever fulfilling that promise because the third party dental insurer makes it so difficult to obtain.  Patients who choose complex treatment plans i.e. over $10,000 after long discussions with their doctors may find it mutually beneficial to eliminate involving the third party dental insurers unreasonable demands and request a $1000 discount for payment of their treatment plans paid in full.  If you still believe Dental Insurance is reasonable, every day attorneys advertise in print and electronic media that you need an attorney to deal with insurance companies to get your promised benefit.  To fight for your benefit, the attorney will “only” charge you 22-50% of your settlement.  With Dental Insurance, your dentist is your “attorney” as a courtesy to you to maximize your benefit.  The dental insurance claim form for your benefit that each patient is required to submit is so difficult that a computer and an average of 1.5 full-time staff are needed to complete it.  The dentist even provides the dental insurance claim form dictated by the third party insurer.  This increases the cost of dentistry.  It would be cheaper to pay your dentist your $600-1000 premium each year, eliminate the third party middle man profit maker, and actually receive 100% of your premium as a benefit.  If the patient had to complete the dental insurance claim form themselves, they would never get any benefit.  Is that the kind of care you bargained for with dental insurance?  If not, then dental insurance is not good for you.

These UCR Fees are inappropriate because they are not determined based on your oral health needs.  They are determined based on making huge Dental Insurance profits.  Your dentist needs to take the appropriate radiographs, probings, examinations and take the time to diagnose a comprehensive treatment plan specific to your oral health needs.  Then your dentist needs to explain your alternatives, benefits, and complications of treatment and no treatment, so that you can make an informed decision about your smile, eating, and speaking ability.  Your insurance company wants to limit your providers, limit your alternatives, deny your benefits, and force you to suffer the complications of delayed treatment until you can’t smile, eat or speak.  Is that the kind of care you bargained for with dental insurance?  If not, then dental insurance is not good for you. 

These UCR Fees are unaffordable because almost everything the sick patient needs is not completely covered by the Dental Insurance.  These UCR Fees are so unaffordable and low that a doctor may be unable to provide quality care unless he forces himself to work very fast for very long hours six days a week on the few inadequate services covered without time for continuing education (CE) with the cheapest materials, supplies, and labs with out-dated instruments and equipment until they are not repairable with the fewest, under paid, overworked, under trained staff available.  Dental insurers force substandard choices on both the patient and the doctor.  Fees are so low now that they do not cover the cost of doing quality care.  Is that the kind of care you bargained for with dental insurance?  If not, then dental insurance is not good for you.

Dental Insurance is supposed to be part of your Health Insurance which is an oxymoron.  Health Insurance is only sold to healthy people who work every day who don’t need insurance.  Health insurance is not sold to sick people who cannot work.  Premium payers think they are buying insurance for when they get sick and need treatment, and are surprised when that is not covered.  If you want to buy insurance when you get sick, it would be called Sick Insurance and cover the treatment you need.  Unfortunately, no one asks you what treatment you need, so the third party insurers sells your employer the insurance that covers the least amount of sickness at the lowest costs, but makes the most profit for the third party insurers.  When it comes to health care, maybe health insurance companies should not make a profit on sick people.  In America, Health Insurance is based on obscene profit and executive bonuses.  Is that the kind of care you bargained for with dental insurance?  If not, then dental insurance is not good for you.


If you are looking for outstanding, high quality, please come to see Dr. Tom with 60-100 CE/year and his long-term, well-trained staff who take the time to care and provide affordable cosmetic dentistry, implants and Invisalign based on your individual oral health needs with digital photography and radiography, the most up-to-date materials, instruments, and the best labs, Monday to Thursday at 4318 South Eastern Avenue, Las Vegas, NV 89119-6016, 702-736-6119, tlcdmd@gmail.com, http://www.drfransontom.com/.  Let us show you the difference, so you can get the quality dentistry your expect and deserve with the least amount of pain and expense in a difficult, uncertain economy.