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06Jun2016

A Word About Dental “Insurance” (And Why It’s Not Really Insurance At All)

THE DICTIONARY DEFINES INSURANCE as: a means of protection from sudden, uncertain, or catastrophic financial loss. Most people mistakenly equate dental insurance with medical insurance when, in fact, dental insurance is quite different (and not really insurance at all).

Medical Insurance vs. Dental Insurance

Let’s look at an example to illustrate this. You walk outside your house and get hit by a runaway street car and suffer multiple catastrophic injuries. This requires a lengthy hospital stay and lots of doctor care and treatments. You have a certain dollar amount that you must pay for your care but after that your medical insurance kicks in (well, in most cases) and saves you from financial disaster or total loss. That’s what medical insurance is.

Now let’s look at an example of how dental insurance works. You neglect your teeth and avoid any dental care for several years until one day you decide to go in because you’re aware that things aren’t right. Sure enough, your mouth is a wreck and requires a lot of care. Unlike medical insurance, which kicks in when costs get high, most dental “insurance” stops paying after it’s paid a maximum of $1,500, regardless of how much care is still needed. It’s called an annual maximum and once dental “insurance” meets the annual maximum, not another penny will be paid until the following year, regardless of needed care at the time. Where medical insurance kicks in when costs get high, dental “insurance” stops when costs get high, leaving you, the patient, to pay the rest.

More About The Annual Maximum

Another note on that annual maximum: it’s been around for a long, long time. I graduated in 1987 and guess what the average annual maximum was back then? That’s right, about $1,500. In fact, the dentist I first worked for had been in private practice since the 1970’s and he told me the annual maximum was about the same, $1,500, when he started too! Now think about that for a moment. Do you think the things we all buy like groceries, housing, entertainment, cars, clothing, etc. have stayed the same price since 1987 or before? Will a dollar today get you as far as it did in 1987? 1971? Yet most dental “insurance” has kept this same cap by limiting what they pay in any year to the same amount: $1,500.

insurance strings_attachedSo, dental “insurance” is not really insurance at all in that it doesn’t protect you from total financial loss. It’s more accurately a dental benefit, albeit with limitations. Limitations? Yes! You see, even with a certain dollar amount dental insurance companies will pay, they still further limit coverage by limiting certain procedures. Hence why anything even remotely cosmetically oriented is often not covered or certain procedures like implants or tooth-colored fillings are not covered, even if they are the best solution for the patient. Dental “insurance” is like a gift card with strings attached to it.

Another Example To Show How Dental Benefits Work

Insurance confusedImagine your Uncle Louie gives you a gift card to your favorite store. You go shopping and see a dress you really like and go to buy it, but at the checkout counter you learn that you can’t use your gift card for that particular dress. Huh? That’s right, dresses aren’t allowed to be purchased with this gift card. Well, how about these nice shoes… nope, sorry. You’ll have to pay for those on your own too. Finally you decide to keep it simple and find a nice, inexpensive, plain blouse that is only $40. You ask the checkout person if you can use your card for this and are relieved to discover that you can. The cashier rings it up and says that’ll be $40 and you cheerfully hand over your gift card only to hear the cashier repeat that he’ll need $40 from you as your gift card has a deductible and doesn’t start paying until after the first $50 is purchased! “What a crazy gift card Uncle Louie gave to me,” you think. But that is exactly how your dental benefits work too! Not only does your dental insurance limit how much they will pay in a year, but they also often deny payment on individual procedures that you and your dentist have deemed necessary for your best interest and care.

Next up: A Word About Dental Insurance Part II

Top image by Flickr user GotCredit used under Creative Commons Attribution-Sharealike 4.0 license. Image cropped and modified from original.
The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.

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