The introduction of dental insurance to the practice of dentistry has allowed the dental health of millions to be improved over the last 30 years. Many on both sides of the insurance card have benefited and been frustrated at the same time.
Much of the controversy has occurred when consumers and dentist alike expected this form of insurance to behave the same as medical insurance had in the past. As we all know, even the medical insurers have had to change their programs due to problems with rising costs of the practice of medicine.
I would like to offer some suggestions to help with the understanding of your dental insurance as a consumer without getting into the details of any specific programs. As a job benefit, dental insurance can be compared to say, getting a company-owned vehicle for your own personal use. It is your employer's choice as to which make, model and color to offer you. It's made available and you may choose whether or not to use it.
Regardless if you have a "Cadillac" or a "Yugo" dental plan, it determines whether the treatments that you need are covered expenses or not. The coverage is not determined by your needs or wants, but by the coverage that your employer has chosen for you.
Your choices can be described with another analogy that depicts dental plans very well. Since no plan covers everything 100 percent, look at the coverage that you have as coupons you might take to a grocery store. You may get some things absolutely free, others may come at a discount and still others may have to be paid for totally out of pocket. Do you plan your weekly meals totally around your coupons or do you throw a few extra things into the cart to satisfy your personal needs regardless of cost? You should look at your dental coverage the same way.
There will be times when the dentist will recommend a treatment for you that is only partially covered or may not be covered at all by your insurance. You will need to discuss with the dentist the timeliness of the treatment and what will happen if it is not completed at all. The decision is ultimately yours and, if you do not like the choices, you must resolve that by asking your employer to change your coverage or asking the dentist for an alternate treatment.
One of the best options is to ask your employer to consider offering a direct reimbursement program. This type of dental insurance is the most equitable for all involved. It allows the employer to know what amounts will be necessary to provide for each employee every year. The employee will decide where to spend the dollars in their dental budget every year and not depend on the insurer to tell them if they have coverage for orthodontics, cosmetic treatment, etc.
The dentist will be able to tell the patient exactly how far they will be able to go in a specific treatment plan before the patient will be using their own funds to cover treatment. Another benefit of this program is there are no requirements for "participation" by dentists. Until this type of program becomes the standard, many patients will find that they will be forced to visit the dentist of someone else's choosing and not their own.