We here at Comfort and Care Dentistry want our patients to understand everything about their dental health and what really dental insurance will do or not do for you. There is a large misconception of what dental insurance is and how to best use it, so here is our attempt at explaining it.
Most medical insurance plans do not have a maximum that they will pay per year, and if they do it is usually somewhere above $500,000.00 dollars. All dental insurance plans
do have a maximum payment per year and they average around $1000.00. That alone is a huge discrepancy between the two and this number has changed very little since the 1970’s when dental insurance plans began. Which means this maximum , has not risen in more than 30 years. This leads to the misconception that your cleanings and x-rays are not part of this maximum. This is because in a medical office when you get your regular check-ups your maximum is so high it doesn’t affect anything. In the dentist office, with a $1000.00 maximum you are only left with $400-$600.00 of benefits after your yearly dental cleanings. This amount is sufficient enough to work on about 1 tooth a year, if anything major is needed.
Here is an example that may help you understand; you come to the dentist and your insurance yearly maximum is a $1000.00, you need a crown on your tooth that had a filling placed in it 15+ years ago, and now the tooth is cracked but not hurting (most dental treatment that is hurting is major and will cost much more than insurance will ever cover, it is much easier and cheaper to fix problems before they are at that point). The Doctor says you need a crown that cost $800.00, but you already had two cleanings that year with x-rays and a couple of small fillings, this took $850.00 of your maximum for the year and now you just have $150.00 left and your part of the crown is now $650.00 and you don’t want it done, or want to wait until next year when you can maximize your insurance benefits. So you wait and then next year the tooth broke even more and the doctor had to rebuild it then using $600.00 of the $1000.00. The doctor also finds a cavity at your first cleaning of the year and fixes it. Now your benefits are gone that year too, you had the crown & build-up, one filling and one cleaning at that was all. Then at the end of the year you want a second cleaning because your insurance said you get two per year, but here are the hard cold facts: your benefits are gone and if you want the cleaning the insurance will not pay for it.
Too many people we see will choose not to come in until next year for their check-up and their teeth worsen due to maximums. I know it is hard to understand, but the only way not to get a cavity is to stop eating, there is the lucky person here and there that have never had a cavity, but for the rest of us it does and will continue to happen. Just think about what you do at least 3 times every day and for most of us this is “EAT”. You are using your teeth constantly and they will wear down just like the tires on a car. We hope this helps you better understand your dental insurance or should I say your dental insurance “preventative” coverage
