The Dirty Secret About Dental Insurance: Why We’re Not Part of the Plan

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not part of the insurance planScotts Valley and Santa Cruz, CA

This is the second installment in a 3-part series. See the first part here.

Have you been to the doctor’s recently?  How much did that visit cost? You probably just paid your insurance co-pay.  But have you ever examined the Explanation of Benefits from your insurance company that arrives weeks after your office visit?  If you look carefully you’ll see that the majority of the doctor’s fee was paid by the insurance.  The doctor signs up with an insurance company to be a “preferred provider” for that plan and agrees to accept a fee schedule that is dictated by the insurance company.  In exchange, the insurance company adds that doctor’s name to a list that is provided to patients on that plan. The vast majority of dental offices operate this way, too.

We do things a little differently in our office.  Over 18 years ago we made the decision to become an entirely fee-for-service practice.  This means that our patients pay us in full for the service we provide, we submit a claim form to their insurance company, and the insurance reimburses our patients directly.  Why did we decide to run our practice this way?  Because we wanted to allow our patients to make treatment decisions that were in their own best interest, not in their insurance company’s best interest.  We already covered in Part 1 how dental insurance is not true insurance – it’s a rebate plan – and how benefits are about 20% of what they should be had they kept up with inflation. These multi-billion dollar corporations are concerned with one thing only: making money! The more they have to pay out in benefits to their subscribers, the less money they make.

What does this mean for you, the patient? It means, for example, that while you may want a small, tooth-colored, metal-free, composite filling, your insurance company may only pay for a large, silver-mercury, amalgam filling.  Now you and your dentist have a decision to make: either you opt for the treatment you want and pay out of pocket, or you settle for what the insurance wants knowing it may not be in your best interest.  We don’t think our patients should have to compromise when it comes to their oral healthcare, or have a third party who is not even present in the office make those decisions for them.  For this reason, we have established a practice model that allows us to provide the very best service without any interference from corporate interests.

Read Part III