|
Plan limitations of dental insurance
Dental insurance isn't really
insurance in the traditional sense. It isn't designed to protect the
customer in the event of a catastrophic loss, but is really a benefit
program that pays out a fairly predictable amount of money for its customer
base. If you take one hundred people, the amount of dental care that they
need as a group is going to be fairly predictable.
To keep expenses in line, the company will sent an annual limit to its benefits. When dental insurance was
first invented in the 1960s, this annual limit was high enough to be able to
cover extensive care. However, while dental costs have escalated, the annual
limits imposed by these plans have stayed about the same, to where
now these insurance plans clearly cover only basic care.
In addition, dental care is different from
medical care or car repairs in that there is a lot of choice in the level of
care. If you have a cavity on the side of a tooth, for example, you need a
two-surface filling. Well, you could get a two-surface amalgam filling from
an "assembly-line dentist" for a certain fee, or, at the other end, you
could choose a ceramic inlay from an expert cosmetic dentist for maybe ten
times that fee. The
dental insurance company, naturally, wants to influence you toward the more
basic care, and they have various policies and procedures in place to move
you in that direction. Often they will have a list of "preferred providers,"
dentists who have agreed to certain fee limitations. They will also limit
the procedures they will cover. For example, let's say you've lost a front
tooth. You would like to have a temporary replacement for that front tooth
while you wait until you can afford a bridge. Almost all dental insurance
companies will disallow this extra expense. Also, when there are various
treatment options, the company will naturally want to pay
for only the least expensive.
There are varying degrees of ethics with which
these companies announce these restrictions. Some of them will be
honorable in their restrictions and just explain to their patients that
their dental plan doesn't cover this procedure, or doesn't cover the full
amount of the procedure. Others will engage in questionable ethical behavior
by trying to persuade the patient to go to a cheaper dentist. To do this
they will say things that imply that the dentist is not correct in the
treatment recommended or that the dentist's fees are too high. They put the
patient in a very awkward situation because most patients don't feel capable
of evaluating the professional competence of their treatment. Complicating
the issue is the understanding that in some cases the dental care may not
be competent. In my experience, however, dentists as a group adhere to a
higher standard of ethics than dental insurance companies. The insurance
companies tend to be very profit-driven. Dentists, while some are unethical,
most are driven by a desire to serve the patient.
|
|
