Dental Benefits Explained

Having dental insurance in this country is like wielding a double-edged sword; you are damned if you do and damned if you don’t. A lot of patients wish they had some sort of coverage when they don’t, and those who have it usually don't end up seeing a dentist as recommended.

Now folks, let me dissect the issue and make it clear. First of all, the term "dental insurance", unlike medical, auto or any other insurance, is a misnomer. It is a dental benefit with a lot of limitations and a yearly maximum.

Dental insurance companies set limits on how many times a patient can get routine care. For example, cleanings and exams once a year. If a patient needs to see the dentist a few more times than the set limit, the patient ends up getting stuck with the bill or the dentist ends up writing it off to please the patient.

To name a few more limits, there is a “Missing Tooth” clause, which states that if you lose a tooth prior to obtaining insurance, the insurance company will not pay to replace it. Be sure to check and see if there is a way around this before you sign up for the benefits.

There is also a “Alternate Benefit” clause, which states that if you are missing one or more teeth on either side of the mouth, insurance will pay for a flimsy partial denture, which I playfully tell patients is the "dinosaur of dentistry". (This option should have been extinct long ago when dental implants became a viable alternative). I rarely do partials, and as a last option, only on medically compromised patients for surgery.

Sometimes I reassure patients with no coverage that they are better off without it. Consider the premiums you pay. If you see a dentist only on an emergency basis and need complex work that maxes out your benefit, you will most likely end up paying a lot out of pocket; you are at loss.

On the other hand, if you do see the dentist on a regular basis, you most are most likely on top of the game and will need very little work (except for routine cleaning and check ups.) Why then, is insurance not paying you back for any unused services or at least letting you carry them over to the next year? Remember, it is an unused benefit not insurance. (Health insurance does not have maximum limits while paying for surgery or treatments).

Do not get trapped with the “in and out of net work provider scheme”. If you like your dentist, stick with him or her. Yes, you pay a little extra co-pay while your insurance company pays the difference, but it gives the dentist a choice of materials and procedural alternatives without limiting the dentist. This way, he or she can deliver quality care without cutting corners or sticking only to eligible services.

I always believe: “You get what you pay for”.

- Dr. Satish