Give me a break. Dental insurance plans are a business
arrangement between the insurance company and an employer. Unfortunately, the reimbursement and benefit
levels are based on carrier and employer business decisions, and not on your need
for treatment. At best, it pays for 2
cleanings and very little after that.
Most plans have a maximum benefit of between $1,000 and $1,500 per year,
which is a far cry from what you really need for your oral health care.
These benefits (I use that term
loosely) haven’t changed since the 1980’s.[1] It’s ridiculous to tie your dental provider’s
hands with reimbursements that haven’t risen in 35 years while the cost of
living has increased dramatically in comparison. Patients that have major restorative or
surgical needs or bite dysfunction cannot afford to delay treatment and spread
it over multiple insurance plan years, because their condition may worsen if not
treated immediately. And none of the reimbursements take into account the added
costs of HIPAA, associated and new technologies.
Like medical insurance, some
dental plans do not offer coverage for pre-existing conditions, such as missing
teeth. This type of plan would not cover tooth replacement procedures, such as
bridges, partial dentures, full dentures or dental implants. And the continued absence of tooth structure
will result in the continued resorption of the jaw bone, further complicating
the possibility of restoration.
Many insurance plans will unilaterally
apply “alternate benefits” towards your service, such as paying for amalgam
fillings rather than tooth-colored composite fillings, or, not covering major
restorative services, such as a crowns, inlays, or Cad/Cam restorations.
Because insurance carriers are
exempt from anti-trust laws, most dental plans use the terms ‘usual, customary
and reasonable’ to determine your insurance benefits. This term applies to fee manipulation used by
dental insurance carriers to set reimbursement levels across the country. The
criteria upon which this research is based, including region, time intervals,
type of dentist, etc., vary greatly from one insurance carrier to the other.
Unfortunately, under the current
system there are very few dental insurance benefits that actually benefit you.
Novy Scheinfeld, DDS, PC
290 Carpenter Drive, 200A
Atlanta, GA 30328
404-256-3620
info@rightsmilecenter.com
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