Is There Really a Benefit to having Dental Insurance?

By: Belle DuCharme, Writer LLC, Director of Training/CE

Dental insurance premiums can be more expensive than simply paying out of your own pocket for routine checkups and cleanings. So, if you’re one of the millions of Americans without dental benefits, is a policy for just the basics really cost effective?

“Most dental insurance policies emphasize prevention and diagnostics, typically covering two annual exams and cleanings, plus X-rays and, for children and older adults, fluoride treatments,” says Evelyn Ireland, executive director of the National Association of Dental Plans, or NADP.

But the real benefit is being covered for bigger-ticket procedures, such as fillings, root canals and crowns,” says Carrie McLean, a consumer specialist with

Fewer than 6 out of every 10 Americans had dental benefits in 2010, per a report released in late 2011 by the NADP and Delta Dental Plans Association.

Dental policies vary widely, and choosing the right one can be tougher than choosing the right puppy from the animal shelter.

What’s covered, what’s not takes a degree in confusion to decipher.

“People with dental insurance commonly have what’s described as “100-80-50” coverage, meaning it pays 100 percent of the cost of routine preventive and diagnostic care, such as checkups and cleanings; covers 80 percent for fillings, root canals and other basic procedures; and 50 percent for crowns, bridges and major procedures,” Ireland says.  And this is good coverage in comparison to some products on the market.

The clear majority of coverage is provided through employee and group policies, plans that charged annual premiums of between $234 and $432 per person in 2011, per NADP estimates.

The cost for you to buy an individual policy averages about $360 a year,” McLean says.

Meanwhile, paying out of your own pocket for two exams and cleanings and a set of X-rays in 2011 would have cost about $370, on average, per the American Dental Association.

When you work in the dental office at the front desk it becomes apparent that many people with dental coverage of $1,000 to $2,500 a year do not use the full benefit.  Typically, the patient is very happy to get the two preventive cleanings, examination and evidence based radiographs because there is little to no out of pocket expense.  However, when it comes to fillings, crowns, root canals, periodontal services or anything else of benefit for health the patient balks because now there is an out of pocket cost.

So really, if you are only going to use the dental insurance for preventive and diagnostic services you don’t need to buy a policy.  Trying to communicate this to patients is only going to get you the glassy eyed stare.  Why is that?  Because many patients believe the insurance is there to protect them from unnecessary treatment.  

I am convinced that you do not disparage the dental insurance in any way but agree to maximize the benefits for the patient per the contract with the insurance provider.  Assuring the patient that you are doing all that you can to get reimbursement for their services up to the maximum benefit provided is not as easy as it sounds because insurance companies do not want to part with money any more than the patient does.

eAssist Helpful News and Billing Tips; Edition #113


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