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Dental
insurance company cost-saving tactics
When you know the "inside scoop" of how dental insurance plans are marketed
to employers, it can be very revealing.
I have seen some of those "pitches," of these companies trying to
sell their plans to employers. They boast of denied claims, slowed claims,
and claims reimbursed for less than charges.
While dental costs have not escalated the way medical costs have, when
employers have been faced with the soaring costs of medical insurance, they
have pressured all insurance companies to cut costs.
Here are methods they have used:
• Annual maximums have not kept pace with inflation. In the 1960s, when
dental insurance was just becoming popular, $1000 was a typical annual
maximum set by insurance companies. At that time, the fee for a dental crown
may have been around $250. Today, when crowns can cost near $1000 or
even more, $1000 is still a typical annual maximum for many dental insurance
plans. Some plans may have increased those maximums, but many haven't.
• They have instituted delaying tactics into dental plans. There are several
worth mentioning. The first is the "pre-treatment estimate." Insurance
companies have requested that dental offices file a pre-treatment estimate
before beginning any procedure that costs more than a certain amount. Say
you need a crown. They want the dentist to file a cost estimate and wait for
approval from the insurance company before beginning the crown. Their
statistics show that, if the procedure can be delayed, a certain percentage
of patients will not complete the work. For those that do complete it, they
may be able to delay payment for two or three months, which is also to the
advantage of the insurance company.
• Another delaying tactic is to introduce some type of mishap into the
processing of the claim. Some claims are denied, or simply not processed.
While often the cause of denial is legitimate, sometimes it isn't. But again
the insurance companies know that a percentage of lost claims will not be
challenged because they may get lost in a shuffle of paperwork. In the case
of a denial, challenges may also get lost in the shuffle or the dental
office or patient may simply not be the type who challenges pronouncements
by insurance companies. When the denial is successfully challenged or the
lost claim re-filed, the insurance company again has successfully delayed
payment.
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