INDUSTRY INSIGHT
DENTAL CARE
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Ask the Dentist
Why Doesn’ t My Dental Insurance Cover This?
What a great question. And with employers continuing to try and find ways to cut costs, one we hear more and more often. The short answer, which came from a medical insurance spokesman, is“ insurance companies are not health care; they are a business; the healthcare aspect is the responsibility of the patient and the doctor.” I can’ t put it any better. To understand more, we need to go back and see where dental insurance started in the early 1970’ s. Almost every procedure was covered at 100 % up to a maximum of $ 1,000-1,500. In the 1970’ s, that took care of almost all a patient’ s needs and wants. Where we are now, in 2016, almost 50 years later, insurers have the same maximums of $ 1,000-1,500( not much adjustment for inflation …). In addition, insurance companies have added all kinds of new jargon such as UCR’ s, Co-Pays, Deductibles, PPO, HMO, etc. These nuances are all meant to confuse the employers, the patients as well as the doctors resulting in lower coverage for the patient and higher profit for the insurance companies. Furthermore, they added fee schedules( which I truly do not understand). These fee schedules don’ t seem to be based on anything tangible and allowances continue to go down, but my, and everyone else I know, costs continue to go up. The logic here makes no sense. Insurance companies further limit coverage by imposing loopholes that no one but the carrier, who put them in place, can see coming. So they will only cover patchwork dentistry to fix structural issues. Kind of like recommending a bandage for a bullet hole.
Which brings us to the next obvious question. What is the best insurance. We get calls on this all the time … It’ s a complicated answer because the best plan we have see in our office is carried by a large carrier that covers all of our fees at 100 %. However, the same carrier also has one of the worst plans we’ ve encountered at the office which covers almost none of our fees. As such, we can’ t really recommend any“ carrier” because plans vary by carrier, as well as within the insurance carrier. Coverage is all based on what your employer has paid into the plan. What we are seeing now is dental being an add on to company’ s medical plans, essentially meaning nothing is paid for the“ coverage,” and as the old adage goes, you get what you pay for.
Where do we fall? At Fox Chapel Advanced Dental Care we accept almost all insurance and will submit all of your claims. However, we don’ t participate in the games the insurance companies play. We charge every patient the same amount whether they have insurance or not. We can’ t justify charging one patient a lower fee and doing lesser quality dentistry than we’ re able, because it’ s what the insurance company dictates. This would require us to charge a higher fee to our other patients to try to make up the difference. We will always provide the best quality materials, technology, and people available in the world to all of our patients whether they have dental insurance or not.
The cost of dental care is, however, a real concern. We offer a family dental plan that is not insurance. You can find more information about these benefits on our website, www. foxchapeldentistry. com.
Hope that answers the question from our practice’ s perspective!
This Industry Insight was written by Dr. Kevin Pawlowicz.
Dr. Pawlowicz practices at Fox Chapel Advanced Dental Care on Old Freeport Road in Fox Chapel. He has trained at the Las Vegas and Seattle Institutes and is a member of the American Academy of Cosmetic Dentistry and the Academy of Laser Dentistry. You can learn more about Dr. Pawlowicz on his website www. foxchapeldentistry. com.
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