What is a Dental Benefit?

What is a Dental Benefit?

Walking a patient through the benefits of their dental insurance is something our staff is happy to do. We can help you process a claim with your dental insurer to make sure you are properly reimbursed for any benefit you have coming to you.

However, keep in mind that dental insurance does not work like health insurance. With most health insurance policies, services are covered minus a deductible. Dental insurance is capped and once you hit that cap, nothing else is covered. In reality, it is more like a discount coupon you get from a grocery store. And the fact is that coupon is not going to fill up your shopping cart!

Dental benefits are typically capped at $1,000-$1,500 a year, numbers that have pretty much remained the same since the 1970s. To get the same kind of coverage afforded to patients 40 years ago, today’s benefits would need to be around $8,000 a year.

What once normally covered 80 percent of your yearly dental costs may now only cover having your teeth cleaned twice a year and a fraction of the cost of maybe one other expense (like having a root canal, an implant placed, one set of wisdom teeth removed or one crown placed, etc.). After that, you’re going to be maxed out for the year.

Technology has changed every aspect of the dental industry and the cost of that technology is significant. A scanner capable of taking a digital impression in a patient’s mouth costs approximately $30,000. The cost for such technology is passed on to patients through increased costs for services. That’s part of the reason why a $1,000-$1,500 benefit goes fast!

And what happens if you don’t use your full benefit? You lose it. With dental insurance costing anywhere from $300 to over $600 a year, you may actually lose money if you only have your regular twice-a-year cleaning.

And what do you get for your insurance? You get less each year. Insurance companies are being more restrictive on what they will reimburse. In some cases, they are deciding if they will reimburse you to have your teeth cleaned the recommended twice a year or if you can get by with one cleaning per year. Think of their savings!

Bone preservation grafting, which is scientifically proven to maintain more bone volume in an area where a tooth was removed so that a future dental implant can be placed, will no longer be covered by some insurers.

And even though an insurance company doesn’t cover a procedure, it can still dictate how much an in-network provider charges for that procedure, thus prescribing the cost of the materials the dentist should use for that procedure. The New Hampshire legislature voted down a bill that would have stopped that heavy-handed practice.

How about this: Some insurance companies will not pay for IV sedation, deep sedation and general anesthesia for more than one hour – no matter how long the procedure takes and no matter what the overhead costs are for the doctor! The doctor is thereby encouraged to stop the procedure around the 60-minute mark, send the patient home and have them return another time to complete what could have been done in one sitting. Sending patients home in this fashion would allow the doctor’s office to be properly reimbursed, but is certainly not in the best interest of the patient.

Unfortunately, dental insurance companies are, more and more every year, limiting how patients can use their dental benefits to pay for the care they need. By watering down dental benefits, dental insurance companies make the “coupon” they provide their patients less valuable.

This is why we at Manchester Oral Surgery have chosen not to play the insurance game of looking at the insurance company’s fee schedule and persuading patients to undergo the highest-reimbursed procedures to make up for other lower-reimbursed ones. Playing this game also encourages doctors to cut costs by using lower-quality materials, trimming staff and by allotting less time for each patient.

Instead, we’ve chosen to focus on providing high-quality affordable care to our patients at a fair fee and still allow our patients to get their dental benefit by using their annual insurance “coupon” to see our doctors.

 

Dr Mark HochbergDr. Mark Hochberg is a Diplomate of the American Board of Oral and Maxillofacial Surgery. He has also earned Fellowship status from the American Association of Oral and Maxillofacial Surgeons, the American Dental Society of Anesthesiology and the International Congress of Oral Implantologists.