Dental Insurance: What You Need to Know

4 years ago

Healthy  Smiles by Rita Tempel, DDS – This article was originally published in the Gettysburg Times, November 16, 2016 

This is the time of year when individuals and employers evaluate new health coverage plans including dental insurance. But many patients are unaware of their coverage limitations. I hope to shed some light on the situation by educating as many consumers as I can through this column.

Dental insurance benefits have deteriorated so badly over the past several years that the Pennsylvania Dental Association (PDA) is asking state officials to investigate. In a recent letter to the Pennsylvania Insurance Department, legal counsel representing the PDA summarizes the current situation: “I write to you regarding a growing and serious concern of numerous dentists regarding actions of certain dental insurers in the Commonwealth which serve no purpose other than improving their bottom line while at the same time adversely affecting the competency and quality of care rendered to their insureds.”

Here are a few common scenarios occurring in my office:

  • Patients have expectations that newly-acquired dental insurance begins immediately, but when they attempt to apply benefits for the first time, they often realize some benefits can be delayed up to 12-18 months.
  • X-rays are considered preventative treatment—one of the best ways to detect the onset of cavities. But recently, some insurance companies aren’t paying for X-rays unless the patient is in pain, when it’s too late to offer preventative care and in fact, treatment is typically more serious and more expensive. Patients often rely on their benefits to guide their care, and are hesitant to pay for X-rays themselves, which compromises their quality of care.
  • Crowns used to be covered every five years under most dental plans. Today, most plans will only cover them every seven to 10 years.
  • In 1970, the average dental plan covered $1,000 of dental care annually. Today, although dental care is more technologically advanced, the average dental plan still only covers an annual average of $1,000. The PDA’s letter states, “dental insurers should at least recognize the costs are consistently and significantly increasing.”

Too often, patients limit their treatment, letting insurance coverage dictate their course of treatment. Insurance companies are simply not offering benefits based on current dental standards of care. Now I should mention, there ARE a few good dental insurance plans. But many consumers are getting sold on dental plans that are limiting, rather than helpful.

So, what can consumers do? Here are a few pieces of advice:

  • Fully investigate and research the specific details associated with future dental benefits before purchasing.
  • Consumers may need to revise their outlook: Purchasing dental insurance can be compared to the purchasing of a coupon book. Once you own the coupon book, if you go out to dinner for example, you are still purchasing dinner but receiving a discount. Similarly, with dental care, you will still have dental costs, and applying insurance benefits as applicable provides some discounts.
  • Find alternative ways to save money. Many dentists offer prepaid discounts, in-house plans, or will allow patients to deposit funds into their dental accounts.

The bottom line: Today, consumers cannot rely on dental insurance to take care of their complete dental health; consumers need to be responsible for their own care. Teeth are considered part of the skeleton—our body’s framework and strength! Dental care should not be restricted; it should help us maintain strong, healthy smiles.

Dr. Rita Tempel is the owner and founder of Gettysburg Smiles/Dr. Rita Tempel & Associates, a family dental practice located at 2018 York Road (Route 30 East), Gettysburg.  She is a Sustaining Member of the American Academy of Cosmetic Dentistry as well as a Preferred Provider for Invisalign. For more information, see GettysburgSmiles.com or contact Dr. Tempel at 717-339-0033.



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