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Perverse incentives and dental insurance

"Maybe if I wait a little longer..."

Dental insurance is a funny thing. It’s almost always purchased by an employer. This employer is usually trying to spend as little on dental benefits as possible. The insurance salesperson explains that they’re getting a great deal as well as fabulous coverage for their employees. The benefits selected by the purchaser don’t really have anything to do with the patient’s dental health or dental needs. Dental insurance is a contract between the purchaser and third party payer that will pay a certain amount, for certain procedures (selected by the benefit company/employer) for a certain amount of time. Dental benefits are like getting a gift card from a control freak. If you need treatment that falls out of these parameters (amount, type or timing) for service, your benefits won’t cover it. Which brings me to my real point.

Dental benefits offer perverse incentives to patients. For one thing, patients almost always choose to break up more expensive treatment into pieces. If a patient could really use two crowns they’ll often choose to do them one at a time in an effort to maximize their dental benefits over a period of years. In some cases this makes sense, but it assumes that there’s no advantage to doing all of the work at once. A perfect example is the patient that could use 2 or 3 crowns on one side of their mouth, say the lower right. What advantages could there be to doing all of them at once? First, it would require less appointments and less numbing. Secondly, if we have a lab fabricate the crowns all at the same time, the shade match can be perfect. As soon as you break up treatment…the shades will invariably be slightly different. Every batch of porcelain is a little different and every lab tech is a little different. Perhaps neither of these things are as important as cost savings to the patient, but they really should be made aware of them.

Another goofy incentive that dental benefits encourage is waiting until the end of the year. The theory goes like this:

“Sure, I know I need a crown on this tooth with a giant filling. But what if I go ahead and do that now and then I break a tooth in October. My insurance benefits don’t renew until January and I’ll be stuck. It’s probably smarter just to wait. I’ll do what he recommends at the end of the year, that way I’ll have my benefits if something happens.”

Admit it. If you’ve got dental benefits, you’ve probably gone through this in your mind. Human beings are great at figuring out the catches in deals that we’ve made. Economists call these incentives. Put simply, they’re the little nudges you get to act a certain way. In this case, the incentive is to wait to do treatment so you’ll have more of the dental benefit gift card (that you’ve already paid for) left at the end of the year, just in case. Why wouldn’t you wait? Let me suggest a few reasons that you shouldn’t wait.

  • Limited appointments: Everyone waits until the end of the year. If your dentist’s office is anything like mine, we get crazy busy in November and December. Since so many holidays fall in these months, the appointments available fill up quickly.
  • Seat date requirements: the same dental benefit companies that create this “let’s just wait” mentality usually require that any lab fabricated dentistry (crowns, bridges, partials, dentures) be billed on the day that they’re placed and not the day that they’re started. Which basically means that unless the dental lab can turn a crown around superhumanly fast, you’re going to need to plan ahead. I cannot bill your insurance on the day that I impression for your crown. Also, labs have a tough time speeding things up at the end of the year…because everyone waits until the end of the year!
  • Teeth don’t care: tooth problems don’t care about your dental benefits and when they roll over. Your very best bet to avoid urgent dental problems is to have “regular dental maintenance” and treat problems as early as possible…which really means right away! Untreated tooth decay has a way of progressing when left alone…and sometimes that means progressing into more expensive and/or painful problems! It’s a lot harder to treat a tooth that’s been broken and/or decayed for a long time than one where the decay was small enough that nothing broke!
  • Insurance companies DO care: they would love it if you’d wait. Because maybe if you wait long enough, you won’t be able to get the work done this year. Then they score by not paying out on their dental gift card that you paid for. That’s why predeterminations take several weeks…(don’t get me started!)

So next time that you’re having that inner dialogue about when you should have some dental work done…just do it! At the very least, you’ll have Murphy’s Law on your side and you and your dentist will have the very best chance to head problems off before they become painful and expensive!

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If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!