Don't Play the Insurance Game

If you thought your medical insurance was bad, let me open your eyes to the USA's largest scam they call Dental Insurance.



Dental Insurance is one of those things ingrained in people to believe they need. If you have a great medical plan, it’s assumed your dental insurance must work exactly the same way.


EXCEPT, THEY DON’T. Dental insurance is NOTHING like medical insurance.


As with all insurance plans, your dental carrier looks hard for a reason to deny you the coverage you’ve paid for. Of the THOUSANDS of individual plans that have come through my office over the last 14 years, I found only two that truly BENEFIT the patient. One is the New Jersey Retired Teachers Association (this is no longer available to new teachers so don't get too excited) and the other is The Texas Railroad Commission, but they’ve also greatly changed their benefits over the last few years. Both plans, if you had them, covered EVERYTHING dental at 100%. I'm talking preventative, restorative, implants, etc. This is how insurance should be. Instead, it's a fight to the death, sometimes literally the patient’s death.


Before I get too far ahead of myself, let me say, if you are a patient who only needs routine dental cleanings & the occasional filling now and then, I highly recommend you consider being self-pay. But even if you have a lot of dental needs, you will most likely max out before you ever get all the work completed, leaving you out of pocket for expenses anyway. Insurance companies downgrade EVERYTHING, even a small tooth-colored filling gets downgraded to what they would have paid on an amalgam filling. What is this, 1970???? With all the research about mercury in the body and yet dental insurance companies still think we are using amalgam. (Yes they are still used in some older, “grandfathered” practices, but just because it's done doesn't make it good).


"MOST PRIVATE PRACTICES HAVE BEEN FORCED TO STOP ACCEPTING DENTAL INSURANCE OR GOING "OUT OF NETWORK" TO JUST STAY AFLOAT. WE ARE HAVING TO CHOOSE BETWEEN PROVIDING QUALITY PATIENT CARE and KEEPING OUR DOORS OPEN"


The dental office I work in has stated we will never allow the quality of patient care to be compromised by limiting it to the narrative of the dental insurance definitions.


Visit a private practice (one that is owned and operated by one dentist) and ask them how many patients their hygienist sees each day. Also, ask how many patients their doctor sees each day. In private practice, I see one patient per hour for a "routine" dental cleaning, x-rays, and exam. In that time, I update a patient's medical history, take x-rays, update their dental chart, go over patient concerns, provide a thorough dental cleaning which includes intra-oral photos of anything I need to show or explain to the patient, periodontal probing of gum tissue as well as discuss any areas of concern I see in the patient. By the time the dentist comes in for the exam, most questions have been answered and he/she is basically confirming everything I just explained. I also create a relationship with every patient that walks through my door. Oftentimes, I watch kids grow to adults and cheer them on through their milestones, I grieve with my elderly patients as their spouses have either become ill and passed or they themselves are going through hard times. While I may only see them every 6 months, I often make small notes about their personal lives in my chart so I can follow up with them the next time I see them.


Then go into a corporate practice (one that accepts ALL insurances, i.e. Castle Dental, Made Ya Smile, etc.) and ask the same questions. I bet you will be shocked, and then that shock should turn into anger. Here's why:


The Academy of General Dentistry has defined corporate dentistry as: “A variety of practice modalities in which management services, at a minimum, are provided in a manner that is organizationally distinct from the scope of activities performed by a dentist within only his or her practice.”


In a corporate practice, you will probably see 5 different providers to have the same things done I described above, had about a 15 min cleaning (if that is even ethical much less beneficial to you), and had a dental assistant polish your teeth. (I will have another article about Licensed Practitioners and why you want one). I also hear from many patients who come to us after a corporate practice who have never had periodontal probing done on them. THIS IS BEYOND UNETHICAL, not to mention borderline ILLEGAL, because those depths tell us what we can't see. The bone level underneath your tissue is the difference between you keeping or losing your teeth. PLUS, because a corporate practice has weekly production goals that they MUST meet, patients are told they need 10 fillings, 5 crowns, and a root canal because those production goals REQUIRE a fixed number of filings, root canals, and crowns completed EVERY week!! What happened to only treating what's necessary?


The reason for this is because, in an insurance-based office, the office has to see 10 times the number of patients per hour to make the same money a non-insurance practice makes seeing a single patient. What insurance pays providers for cleanings, fillings, crowns, etc is a JOKE!


In the last 2 years, dentistry has seen a brutal rise in costs of day-to-day supplies due to several factors such as material shortages (gloves went from $5/box to $45+/box) and hygienists walking away from dental offices due to burnout from overload and demanding higher pay, etc.You would expect insurance companies to also be increasing their reimbursement fees to providers. NOPE. In fact, Delta Dental, one of the largest dental insurance companies, sent a letter out in January 2022 advising those still in-network dentists that they would be REDUCING their pay-out cost by 30%!!!!! Did your monthly premiums go down by 30%? No, they didn’t.That’s why you should be angry - because Delta Dental’s revenue in 2021 was $422,985,566. I'll bet many of you whose dentist was still in-network with this company recently learned your dentist was dropping this insurance ..... because at this rate they might as well be paying YOU for getting a cleaning or filling done.


Dental Insurance is a SCAM and corporate dental offices are the death of quality patient care as we know it. What once was every patient has a name, has become a cattle call of “turn ‘em and burn ‘em”, all for the sake of their bottom line. As usual, it will be you, the patient, who suffers. And you won't know any better because you can't see the work done, but you will when it fails.