Dear dental insurance patient…

November 6, 2018

By Katrina M. Sanders RDH, BSDH, M.Ed, RF

Article

Unmasking the numerous myths about dental insurance plans.

Thank you for taking a break from your meticulous flossing and full two minutes of thorough toothbrushing to read this letter to you.

This letter, written by your concerned dental provider, is being sent to unmask several myths about your dental insurance plan.

With the holidays fast approaching and the end of the year upon us, I’m confident that you’re doing all you can to maximize your insurance benefits.

While we all love being overbooked on New Year’s Eve so that we can squeeze in last-minute treatment prior to the end of the year for the sake of maximizing your benefits, I wanted to share a few tips to help you better understand your dental “discount” plan.

Click through the slides to unmask myths about dental insurance plans.

1. Insurance companies don’t understand your dental needs and won’t cover most of your dental needs anyways

This may go without saying, but your dental insurance company doesn’t know you. They haven’t taken the time to review your medical history, inquire about your dental concerns, learn about your family, examine your oral tissues, X-ray your teeth, evaluate your bleeding, or inquire about how to improve your oral health. They don’t know about your recent cruise to the Bahamas, they haven’t seen photos of your daughter’s cheerleading championship, and they never remember that you need a neck pillow and unwaxed floss during your dental appointment. Quite frankly, not only do they not know these things, but I implore you to consider that their job has nothing to do with your needs and everything to do with reading between the lines, hidden clauses and fine print.

As trained dental professionals with years of education, we continually strive to support you in encouraging optimal oral and systemic wellness. We take continuing education coursework to train us on the most recent research and state-of-the-art techniques. We meet for morning huddles where we discuss how we can best serve your dental needs, we uphold a professional responsibility to treat you with the upmost care, and we truly care about your overall health. This means that we make recommendations based on the identification of disease, and these recommendations may be newer, cutting-edge technology or techniques.

Despite these recommendations, dental insurance companies have strict guidelines on what procedures are (or the more likely option: what procedures are NOT) covered. Covered procedures often don’t align with the newest research or techniques, and this leaves your dental provider wondering how to best serve you. In fact, most dental providers would argue that they’re able to freely provide a higher quality of care to patients who don’t have dental insurance, as there are no limitations on the procedures, frequencies and techniques that can be used.

While we do care about doing all that we can to best maximize your insurance benefits, please know that we were trained by authorities in dental and periodontal medicine and our decisions SHOULD align with recommendations of research-based entities, not your insurance company. (Please note use of the word “should” in the sentence above).

2. We’re often uneasy about recommending treatment that your insurance doesn’t cover

As a dental hygienist, I pride myself in being a preventive specialist. My job is to identify risk factors for disease and address them before you succumb to the manifestations of chronic disease. This means that it’s my responsibility to diagnose chronic inflammation, early dental decay, suspicious oral lesions, and disorders of the mouth, jaw and face that could contribute to advanced oral and systemic diseases. Upon identifying these risk factors, I proudly said a vow at my dental hygiene school graduation that I would assume responsibility for letting you know about these risk factors and making recommendations for how to address them.

Sounds easy, right?

It’s not, and here’s why.

Dental insurance isn’t a wellness plan, it’s a “sick care” plan. Dental insurance will not pay for me to place a fluoride treatment over that early cavity, but it will allow me to sit and watch it until it breaks into your enamel and requires a filling. Dental insurance will not pay for an additional dental cleaning to help me manage your gum inflammation, but it will allow me to watch your inflammation exacerbate into an irreversible disease process that research has identified as a major cause of several other diseases. Dental insurance will likely not pay for me to use antibiotics to treat the bacterial infection of periodontitis, but it will allow me to sit and watch as it leads to tooth mobility. And here’s the plus: Insurance will pay toward having your diseased tooth removed. Dental insurance will not pay for me to perform an illumination oral cancer screening technique, but it will allow me to sit and watch it grow into a larger lesion, and they’ll pay for a doctor to biopsy the lesion when it’s likely further along in the stages of cancer.

So why don’t we just tell you, our beloved patient, about these important preventive procedures?

Because our biggest fear is that we’ll spend time sharing the importance of a preventive procedure only for you to ask me “Does my insurance cover it?”

No, Susan, your insurance won’t cover it, and it hurts my heart that I now get to sit back and watch your disease manifest because you wholeheartedly believe that if you really needed it, your insurance would cover it.

My auto insurance doesn’t cover oil changes, but I’ll still get them because I learned in Girl Scouts that it’s important (and also my super Midwest Dad checks on stuff like that). Let’s stop treating our cars with better care than our own bodies because, unlike a car, you can’t trade in your teeth for another set.

3. We do a lot of dental work that we don’t bill to your insurance or to you

I’ve heard the saying more times that I would care to admit: “I’ve put Dr. Smith’s kids through college” or “Dr. Jones must be going on another cruise because of all the work I need to have done.” With all due respect, there’s an immense amount of investment that our doctors make in their practices: the purchase of equipment, staff salaries, advanced training, and even simply paying to keep the lights on means that very little of your out-of-pocket funds make their way to our student loan-carrying doctors.

With that being said, I find it important to share that there are several dental procedures that I consistently perform on patients like you that aren’t billed to your insurance nor are you charged for them.

Oral hygiene instruction: Every time I ask you about your flossing habits, take time to show you how to angle your brush bristles along the gum line area, hand out a mouth rinse sample, or show you how to use a new dental product, I’m providing a service that the American Dental Association states I can bill you for. Check your statement from your last dental visit; I’m confident you likely weren’t billed for oral hygiene instruction.

Nutritional counseling: Any conversation about reducing fermentable carbohydrates in your diet, comprehensive assessment of nutritional deficiencies, or recommendations to increase certain food items to aid in the control of your chronic oral disease is a service in which I can also bill you for, according to the American Dental Association.

Tobacco cessation: My favorite saying is “You know smoking is bad for you…” followed promptly by “I’m sure I’m the first person to tell you this, right?” The truth is that we’re highly trained in counseling our patients through the process of quitting smoking or the use of smokeless tobacco. And, you guessed it, I’m absolutely able to bill you for it, according to the American Dental Association.

The truth: I’m using advanced education and sophisticated knowledge that I’ve acquired through my specialized training to help promote oral and systemic wellness. In all honesty, I believe that dentistry is one of the only industries that offers so many counseling services for absolutely no fee. Try asking your personal trainer, life coach, therapist or family attorney to offer you counseling or training for no fee and I’m confident you won’t get very far.

Nevertheless, we’re happy to support you, billed or not, because at the end of the day, it’s your personal wellness that we care about most.

4. While dentistry is evolving, dental insurance isn’t

While dentists (or barbers) have been performing dental procedures for centuries, dental insurance is a relatively new concept. In the 1970s Delta Dental constructed the very first dental insurance plan. This dental plan covered minor procedures and allowed an annual maximum of $1,000 per person.

Fast forward 50 years later and here we are: Dental insurance covers minor procedures with an annual maximum of $1,000 per person.

In 50 years what has changed? We stopped painting our walls with lead-based paint, we discovered that the glamour of cigarettes doesn’t outweigh the risks of smoking, and we now encourage pregnant women to abstain from drinking alcohol. In dentistry, we’ve completed research in countless aspects of the industry linking oral disease to generalized illness. We’ve researched regeneration techniques, host modulation therapies and supportive preventive techniques. These are fancy words that didn’t even exist in the 1970s but are drivers in today’s industry of prevention and active therapy.

Most compelling though is the fact that of all things that have changed, our economy and inflation have changed the most. Have you ever looked up what a gallon of gas or stick of gum cost in the 1970s? “Wow, can you imagine?” Absolutely!

So why is it that in the 1970s patients were permitted a $1,000 maximum and today you’re permitted the same maximum despite the inflation in the American dollar, advancement in procedures and increased awareness of the importance of oral health?

I think I’ll just leave this section with the above hypothetical question, as I’m truly curious myself…

5. We fight on your behalf

As a concerned dental provider, I must say it: Just because your insurance plan doesn’t cover it doesn’t mean you DON’T need it. Additionally, just because your insurance plan tells our front office that they may cover a procedure doesn’t mean they will in fact cover the procedure. Many insurance companies have entire departments dedicated to looking through our documentation and finding any opportunity to decline your treatment.

Our front office staff, doctors and clinical team take numerous courses on identifying the documentation techniques necessary to twist the arms of your insurance company, so to speak. We promise: those X-rays that you’re arguing with us about taking, the comprehensive health history we’re gathering, the gum tissue charting, or the dental history we’re asking about are going to be used as solid documentation for why we must complete specific procedures.

Even after you’ve left our office with a face full of anesthesia and beautiful dentistry, our front office team works tirelessly to continue to secure a payment from your insurance company. Sometimes your insurance won’t cover the procedure that was performed. In those events, our front office team goes into your account and performs an “insurance write-off,” which is essentially a momentous kick-in-the-pants to the provider who just worked their behind off on ensuring your mouth is in a state of perfection.

We promise that we do all we can to work on your behalf to support you even after we’ve cared for your dental needs, so please be kind to our front office.

With this, I must share that I appreciate dental insurance for the ways in which it helps to provide opportunity for so many people to receive dental care. For that, I’ll be ever grateful to dental insurance companies.

I look forward to continuing to provide exquisite, cutting-edge dental care to you and your entire family with the immense support of your dental insurance company.