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THE EVER-CHANGING INSURANCE LANDSCAPE
by Bethany Petty
After nearly 25 years in the dental field , I have certainly seen the metamorphosis of dental insurance . With dental benefits arriving on the scene in the 1950s , the industry is much newer than the medical benefits industry and has progressed ( or digressed ) in a very different way . Initially , there was very little diversity in dental insurance plans . They all had similar parameters with an annual maximum benefit of $ 1000 and the typical breakdown of 100 % preventative , 80 % basic , and 50 % major coverage . The rules within each of these categories were either identical or very similar .
Fast forward to 2021 , and there are now hundreds of different dental benefit plans provided by a wide variety of insurance companies . The maximums can range from $ 500 up to $ 10,000 or more , although most still fall in the $ 1000 to $ 1500 range . The categories of preventative , basic , major , and ortho exist as the primary categories , but the procedures in each of these categories now vary widely . The clauses , waiting periods , and frequency limitations now seem as unique as a fingerprint .
The growth of the dental benefit industry led to the eventual popularity of the preferred provider network where dental offices contracted with insurance providers . These contracts started as an agreement where dentists agreed to a small discount on their fees in order to be marketed through the dental insurance plan . Although it took years to gain popularity , it eventually exploded and led to a majority of dentists joining the networks . The popularity of the network led to lower reimbursements from insurance companies because they had a fully saturated market . Currently , the negotiated fee schedules are often 40-60 % below the full fee of the practice .
Although verifying benefits and getting accurate information has always been a challenge , dental teams have been able to find and store employee specific plans . Up until 2020 , dental team members were still able to get mostly accurate information from the dental benefit providers . Once an office team member confirmed the parameters of the benefit plan , the dental benefit information was usually good for a year because changes to coverage or clauses primarily occurred once or twice per year .
Since the pandemic , dental benefit providers are making regular plan changes making it impossible for team members to stay up to date with information . For example , some insurance companies are dropping the age limit for fluoride . Some are utilizing orthodontic benefits for orthodontic extractions . Others are increasing their waiting periods . Changes have always occurred with insurance companies , but now these changes are happening four , five , or six times a year . In some cases , an insurance plan has been verified a week ahead of the patient ’ s appoint-
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