When I started practicing 20 years ago, the maximum yearly benefit allowed by even the best dental insurance companies was about 1000-1500$. Fillings were about 85-100$. Cleanings were about 45-50$ and crowns were 650$.
As time goes on, services and things, in general, get more expensive. Never cheaper right? Crowns are now north of 900-1000+. Cleanings are 90-100$. And Fillings are 180-200+. Do you know how much your dental insurance has increased your yearly benefits in the past 20 years? ZERO! NONE!
The maximum each year for dental insurance is still 1000-1500. And you know how long it’s been like that? Way before I started practicing. In the ’70s and 80’s it was still 1000-1500$!
Oh. But you know the AVERAGE bonus the CEO of Delta dental gets EACH year? 5million dollars. Bonus. On top of the annual salary of 3 million. Now I’m not a genius by any stretch. But that just doesn’t add up. It defies economics for any industrialized country. Especially in the US where health and medical care are supposed to be a global example. Oh. Wait. I forgot. Something HAS changed with your dental insurance. Their actual coverage for you has DECREASED and become more LIMITED. Yes. That means they are covering LESS for the treatment you need and are putting more exclusions on what they cover and why. Do you think that the bridge needed to replace that missing tooth is covered? Nope sorry. You had the tooth pulled PRIOR to getting insurgence.
Do you think that cleaning will be covered? Oh. So sorry. You just had a cleaning 5 months and 29 days ago. They only pay for cleanings every 6 months. You need a deep cleaning bc you haven’t seen the dentist for 3,4,5 + years and now have a brick wall of tartar covering your teeth and your gums bleed if you look at them wrong? Oh sorry! You’re under 35 so insurance will come back with a blanket rejection of your claim based SOLELY on your age and NOT on the actual condition of your gums that we, the doctor, describe to them in great clinical detail. You had an emergency? Oh good! That IS covered!! But guess what? it ate up all the benefits you had for the year so now they won’t pay for ANYTHING else dentally related.
And this is the continuing pattern only trending worse.
Egregious rejections of valid claims for you is rampant. United Concordia is one of the biggest offenders. So even though your treatment is a needed and covered benefit, the insurance companies will send a rejection of your claim hoping that the patient won’t fight it bc it’s too much trouble. (We fight on your behalf. Mercilessly. ).
Another game insurance companies play is called “get the preauthorization” first game. Say you need dental treatment like a crown or an implant. You call the insurance company to see if they’ll cover it. They will say “have your dentist send in for a preauthorization”. And so we do. It may come back saying that they will pay something towards the treatment ...it’s never 100%..but they will pay something. BUT on the VERY first line of the whole letter is something in tiny letters saying “This is not a guarantee of payment”. So when we send in the actual claim for this preauthorized work, they can still reject the claim outright for any reason they can make up. And it’s all legal!
The preauthorizations are a way to delay treatment and insurance companies hope that the patient loses interest in doing the work after time goes by. BECAUSE if the patient wants to wait for the 6-8 weeks for the preauthorization to come back, the insurance companies know it’s not an emergency. So if it’s not an emergency, they know that patients 78% of the time will put off or not do the dental treatment! So guess who doesn’t have to pay any benefits and lose money? Yep. The insurance companies!
Call Your Glendale Dentist
The purpose of this ranting article is not only to vent off increasing frustrations about an institution that takes advantage of patients. But to hopefully educate you, the patient, about how your dental insurance actually works. Because when you know how they work and you know the rules, you can play rough in their playground and with their games.
Just know that I and my staff are tireless advocates for you and your oral health and move mountains to maximize your benefits and to help you plan your treatment and avoid any unexpected financial surprises.
If you have any questions about your dental coverage, call us and we can help you navigate your benefits.