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Browsing 8 posts in dental insurance.

The Clock is Ticking

Vintage alalrm clock on yellow backgroundThe Halloween decorations are still up, but not for too much longer. It’s still about ghosts and goblins for now, but soon it’s going to be more about turkey and stuffing.

I hear this noise. It’s a quiet, barely audible ticking. But it seems like it’s getting a little louder. And a little louder.

You see, although the calendar says we have 1/6th of the year left, it kind of lies. Because time in the last two months of the year becomes much more precious. The holidays bring their own special kind of busy. Whether it’s stocking up for a Thanksgiving feast or Christmas shopping for the grandkids, everything takes time.

If you’re anything like me…you’ve let things pile up. You’ve got a lot of things you were hoping to get done in 2017 and now we’re getting close to the end of the year.

A lot of you probably left some needed dental work until now. Now is the time you can use benefits without worrying about the fact that you “might need them for an emergency.” Your benefits run out at the end of this year and you’re leaving money on the table. You’ve already spent those dollars on premiums or spend downs. My friends, that money is gone.

If you’ve got benefits left and treatment that’s been diagnosed…it’s go time. It’s “let’s use the benefits we paid for time.” Let’s do this.

Call (989) 799-9133. As of now (November 1st…and counting) we’ve still got a little room on the schedule. But it’s going to fill up.

Do. Not. Wait.

That ticking you’re hearing…it’s going to get louder.

Did this make you feel urgent? Are you feeling like you need to get some dental work done? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

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 I always answer my own emails!

The future of dental insurance?

Delta Dental of Michigan just began offering a new kind of dental insurance to its employees. The insurance plan is being sold as “personalized care.” What a great service! They care about you as an individual! They actually test your genetic code to determine the best treatment for you, right? Well…sort of. Here’s a short version of how it works.

How the new "personalized dental insurance" plan works

How the new “personalized dental insurance” plan works

Adults will be given a baseline level of preventive coverage. This baseline includes one “cleaning” and two exams covered by insurance per year. Additional “cleanings” will be covered (a maximum of four) if you have one or more risk factors. The new program includes the following risk factors:

  • diabetes
  • history of heart attack/stroke
  • renal failure/dialysis
  • suppressed immune system
  • history of radiation of the head and neck due to cancer
  • pregnancy
  • a history of a periodontal disease/past periodontal disease treatment

Furthermore, a subscriber to this insurance policy may choose to have a genetic test done for the “periodontal disease gene.” If they test positive for this gene, they may qualify for more “cleanings.”

You may be wondering why I’m putting quotes around the word cleaning in the previous paragraphs. It’s because I kind of hate the term “cleaning.” It means different things depending on the patient’s gum (periodontal) health. So let me clarify. If you’re a healthy adult patient with no periodontal disease, you’ll most likely get a dental prophylaxis. This consists of a hygienist or dentist removing plaque and tartar that his harder to reach by regular home care as well as the crowns of your teeth polished. That’s the smooth and minty feeling you get after they finish up. If you have periodontal disease, which is to say that you’ve lost some supporting bone around your teeth, your cleaning is actually considered periodontal maintenance. This assumes you’ve had periodontal therapy (deep cleanings, aka: scaling and root planing). This is a much more in depth removal of tartar which may include local anesthesia and localized deep cleanings on the roots of the teeth. However, both of these things are (erroneously) being referred to as a cleaning, even though there are very specific insurance codes for each type.

At first glance, this really does seem like dental insurance  providing true personalized care. Delta Dental of Michigan designed the plan based on some recent research from the University of Michigan that may indicate that 2 preventive visits to the dentist each year are no better than one at preventing disease.

Delta Dental seems to be indicating that this new, evidence based plan that treats patients based on their risk factors for disease is the way to go. I am very interested in letting good scientific evidence help guide the way we treat patients. I think this is in everyone’s best interest. That said, I think this plan is premature at best and disingenuous at worst. I think Dental Dental’s foray into personalized care is heading in the wrong direction for several reasons.

  • Weird Science: The new insurance policy is based on a University of Michigan study called “Patient Stratification for Preventive Care in Dentistry.” The study was designed to see if two recall appointments (“cleanings”) were better than one. The results would lead one to believe that two cleanings are no better than one. From what I can tell, this is the entire basis for reducing the number of baseline “cleanings” the patients with this insurance policy would receive. But there is a problem with this research. The outcome that the study measured was “tooth loss.” Which is to say, two cleanings is no better than one cleaning if your only concern is losing teeth to periodontal disease. Losing teeth due to gum disease is clearly a huge concern, but there’s a lot of other concerns (gingivitis, tooth decay, crooked teeth, tooth wear and dry mouth to name a few) that this research doesn’t address. “Tooth loss from periodontal disease” is a pretty blunt measure of whether 1 or 2 cleanings per year is better. It seems to me that most patients aim higher than just not losing teeth to gum disease.
  • No smoking?: Delta Dental listed many risk factors that they take into consideration when allowing for added “cleanings.” Diabetes, history of stroke/heart attack, suppressed immune system and even a genetic predilection toward gum disease. What didn’t they list? Smoking. Many believe that smoking is perhaps the most relevant risk factor of all when it comes to gum disease. Yet Delta Dental doesn’t list this as one factor that might qualify a patient for more covered recalls? What is that all about? Is it a moral stand against smoking? Whatever it is, they’re ignoring perhaps the most important factor in the development of gum disease. Since the new policy is based on research that judges tooth loss by gum disease, it seems that Delta Dental is picking the risk factors that benefit their bottom line more than the patients they serve.
  • What about tooth decay?: As I mentioned before, this research measured tooth loss due to gum disease. The elephant in the living room is the fact that they didn’t mention risk for tooth decay. Gum disease is common, but not nearly as common as tooth decay. For people with a lot of risk factors for decay (dry mouth, lots of medications, diet, soda consumption, poor home care), 6 months is probably too long to go without being seen by a dentist. For these folks, a year is practically a lifetime! Tooth decay can proceed very quickly in a high risk patient, yet they may not test as high risk for gum disease, which means that under a plain like this, they would likely only have one “cleaning” per year. While cleanings may not directly affect tooth decay, the fact that the patient is presenting to the dental office means that the dental team is much more likely to catch problems (e.g–cavities) while they are small and easier to treat.

cool looking dental hygienist clipYou might be thinking, “O.K. Doc. I hear you. But you’re missing the point. The insurance policies still pay for two exams per year. I can come in to see you twice and you’ll still get a chance to evaluate my teeth. Even though they won’t be as smooth and minty as before, I’m still getting all that preventive benefit. I think this is really about dentists losing all that revenue from cleaning teeth. So just pipe down.

Honestly, this is a semi-reasonable argument. The insidious part is what the insurance companies know that regular folks don’t think of. Whether you want to believe it or not, we human beings are driven by incentives. As much as I like to think that I can teach all patients about their needs, I’m still almost always limited in my treatment options by what the insurance will cover. Patients with insurance like to use their insurance benefits and they take seriously the limits that insurance policies place on them. If a patient has been used to coming every 6 months for a cleaning ever since they were a child, how likely are they going to set up for that second examination if they don’t get a cleaning? I can see it now: “So you want me to miss work so I can come over here and have you look at me for 15 minutes? I don’t get to spend quality time with April or Tanna gently polishing the plaque off my teeth? All I get is Doc shining that bright light in my eyes? Well, thanks but no thanks. I’ll pass until my next cleaning is covered.

I’ve written previously that cleanings are overrated. Apparently the insurance companies are beginning to agree with me. I hope I’m wrong.

Did you find this post ominous? Perhaps a bit scary? This dentist in Saginaw, MI would love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a Saginaw dentist, 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 I always answer my own emails!

Ghost of Benefits Past

iStock_000018159844XSmallIt’s that time of year.

“What time of year is that? The time of year when we look forward to family time, turkey, football and gawdy Christmas sweaters?”

Well, yes. It’s that time of year, too. But I was thinking more of the time of year when you realize that you have dental benefits left. Since dental benefits are nothing like real insurance you realize that if you don’t use those benefits before the end of the year…they disappear. Where do they disappear?

Into the insurance company’s pockets!

I’m not trying to be a Scrooge here, but it’s true. Your dental “insurance” company would love it if you don’t come in until after New Year’s Day! That way, the benefits you were entitled to for 2013 are gone and they start the clock ticking on 2014. They’re hoping that maybe you’ll wait until the end of the year next year, too! On top of that, most dental benefit companies require that procedures involving lab work be placed before you can charge the dental benefits. And lab work takes time! You need to get in sooner rather than later to make sure you can be finished!

Christmas shopperThe holiday season is already tough. We’re in the office less in November and December because of the holidays. And you’ve got more stuff going on, too. So…make your appointment now! If you wait much longer, you’re going to run out of time! We’ve still got spots available to take care of your dental needs. But time is running out! Give us a call at (989) 799-9133 or use the “make an appointment online” link above and we’ll find a time for you in between making the stuffing and finding some really bad cologne for dad. Don’t let the ghost of dental benefit’s past catch up with you!

6 Months from Christmas

iStock_000020505277XSmallDental benefits make us do weird things. No, seriously. Because most dental benefits have a certain amount that they’ll allow each year, patients feel like they need to wait.

“I know I need a crown replaced on the upper right, but what happens if I break a tooth on some popcorn? Maybe I’ll just wait until the end of the year so I know I’ll have my dental benefits left then.”

Since Christmas is 6 months away today, here’s an gift to you. Four reasons why you shouldn’t wait until the end of the year to have your dental work done.

  • Most dental problems don’t get better on their own: It’s human nature to think maybe if we ignore the problem, it will get better. Acting like it’s no big deal that you can’t eat ice cream without almost crying doesn’t fix the problem. Also, broken fillings don’t miraculously replace themselves. You need to get these things taken care of.
  • Summer is pretty leisurely around here: Right now, we’ve got time for you. Lots of people are vacationing and spending time up north. So this dental office is more flexible with appointment times than we are from about October until the end of the year.
  • Most dental benefits are “use it or lose it”: Dental benefit companies understand human nature much better than regular folks. By only allowing a certain amount of benefit per year, they encourage you to wait on treatment. Because, you never know… “Maybe if I just get by until November I can be sure I won’t have an expensive dental emergency that I didn’t plan for.” So, a certain percentage of folks with dental benefits will wait. And some of them just keep waiting. The dental benefit companies love this, because they’ve already been paid their premium, and if you don’t end up using your benefits for the year because you’re waiting…they win!
  • We’re going to be closed between Christmas and New Year: Our office has prided itself on being open through the holidays for years. In fact, I even wrote a poem about it a couple years ago. We’ve been planning and working really hard on our new office this year, so we’re taking some time off in December. Which means our “end of the year rush” time just got shorter. It’s going to be a lot less likely that we can accomodate last minute “I need to use my benefits up” rush this year.

Jingle BellWhat I’m saying is…let’s take care of your dental stuff now. If it makes you feel any better I’ll wear a red and white hat and play holiday music.

Did you find this post merry? Did it make you think of jingle bells and holly? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

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 I always answer my own emails!

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!

Did you find this post hard hitting? Insightful? Pretentous? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

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 I always answer my own emails!

Like a gift card from a control freak

"I haven't been to the book store because I haven't had a gift card..."

Bookstore employee: “Hi, how can I help you?”

Customer: “Well, I haven’t been to the bookstore in a long time because I didn’t have a gift card. But my employer bought me a gift card, so I’d like to buy some books! I was thinking of getting the latest Stephen King novel.”

BE: “Oh, I’m sorry. Your gift card won’t allow hardcover fiction titles. They only allow for paperback. We do have several of his older titles in paperback, though.”

C: “Hmmm. O.K. Well, maybe I could try something in nonfiction. Maybe Freakonomics or The Tipping Point?”

BE: “Again, I’m really sorry. This gift card can only be used to buy boring nonfiction. Interesting nonfiction isn’t covered by your gift card.”

C: “Jeez. O.K. So, maybe I’ll just get this magazine then.”

BE: “That’s fine. Your total is $6.95.”

C: “Wait. Um. I’d like to use my gift card. Can I do that?”

BE: “Your gift card has a deductible. You can’t use it for purchases under $50. So, is that cash or credit?”

Dental “insurance” isn’t really like insurance at all. Insurance is meant to protect you against unpredictable calamity to yourself, your family and your stuff. For the most part, dental care is something that can be planned for and isn’t “calamity based.” A lot of dental care consists of regular maintenance which is distinctly different than a heart attack, a car accident or a flood…events that normally are covered by insurance.

Dental benefits are a lot like a gift card. Your dental benefits give you a certain amount of money to be used toward dental care in a given year. Most plans don’t allow you to carry over an unused amount to the next year, so it’s “use it or lose it.” The incentive to the patient is to use their “insurance” to the fullest.

So, if the insurance companies know that they’re obliged to give each subscriber $x/year when the premiums received are less than this amount, how can they make money? They have several strategies.

  • The insurance company knows that a certain number of people are not going to use the benefits that their employer paid for. Many people won’t see the dentist even if they have a “gift card” that will help pick up the bill. To the insurance company, this is free money.
  • Most insurances have strict control over what they will allow patients to use their benefits for. Some policies won’t allow you to use your dental benefits for tooth colored fillings. Some policies won’t allow x-rays each year. These limitations control costs by requiring the patient to pay more “out of pocket” for them if they decide they would like to have the service done.
  • Some insurances cover nothing on really valuable dental services. Dental implants are the best treatment for missing teeth that dentistry has to offer. Most dental insurances will not allow you to use your benefits for the surgical placement of an implant, even when they will allow you to spend your benefits on a less conservative treatment like a bridge or a partial.
  • Some insurances require that the patient pays a certain amount out of pocket before being allowed to use their dental benefits. This is called a deductible and is one more way to discourage subscribers from using their benefits.

So if dental benefits are like a gift card, the gift givers are control freaks! I’m not claiming that dental benefits have no value. People with little or no dental problems will do great using their dental benefits. But like a gift card, dental benefits may not cover all of what you want or need for dental care. The mistake that many patients make is to believe their dental needs are in some way related to how much money they have on their gift card. If you’ve got a gift card for $15 in the bookstore, you’ll be able to pick up a couple magazines, but you’ll probably have to kick in a little if you’re looking to pick up the latest John Grisham hardcover.

If you like this post, I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1” on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

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 I always answer my own emails!



Yearly maximums: how dental insurance companies save money…for the dental insurance companies (part 2)

This is the second installment I'm writing about dental insurance.  The first one is here.  I'm fascinated by medical insurance.  I'm fascinated by "health insurance reform."  Am I fascinated by dental insurance?  No.  Not at all.  Mostly annoyed, really.

I have to admit that there are probably a lot of teeth that have been saved by dental insurance.  But the incentives that it sets up for patients are damaging in a similar way. Delta Dental pond

(Delta Dental of Michigan's headquarters—–>)

Nice pond!

Let's say a patient has stayed away from dental treatment for a lot of years "because they didn't have dental insurance."  Unfortunately, this is an everyday occurrence.  They may have a lot of different dental problems from years of neglect.  They might have decayed or fractured teeth, gum problems or missing teeth.  They're excited to get in and use their new dental benefits and get back to dental health.  They have a yearly maximum benefit of $x that they can put toward this dental care.

After examining the patient and diagnosing their dental situation we find that the patient needs $4x of dental work.   W796dollar-sign-1981-posters

So their dental insurance might cover 25% of the cost of their needed treatment and they've decided that they don't have extra money outside of what their insurance will cover.  What does this do?

  • First, it makes the patient prioritize what's "most necessary" for treatment.  It also makes the dentist attempt to prioritize what would benefit the patient the most knowing that the entire treatment plan won't be done at once.  Although prioritizing isn't necessarily a problem it is almost always a compromise in treatment.
  • Secondly, it reinforces the idea that dentistry is "expensive."  Dental insurance is meant to help with the costs of regular maintenance of dental health.  It's not meant to completely pay for dental treatment.
  • Finally, it adds an unwelcome aspect to the dentist/patient relationship.  Why doesn't my insurance cover more of this treatment?  

Dental treatment is expensive.  But costs can be controlled and planned for when a patient sees the dentist regularly and there is an open and honest communication between the dentist and patient.  The insurance companies often complicate this relationship.

I think one of the problems with this dynamic comes from the confusion between dental insurance and medical insurance.  Medical insurances rarely have a cap on how much will be covered in any given year. If a patient has an expensive diagnosis like cancer, medical insurance generally doesn't limit how much will be paid out for a patient's condition.  However, cancer treatment costs much more than what a company receives in premium payments for an individual patient.  They lose money on that, but society wouldn't stand for an insurance company choosing to limit this payout on a cancer patient.  

A question that's worth asking is "when was the last time that money was discussed with you prior to treatment in a medical situation?"  In most cases the answer is "never."  We don't talk about money when it comes to medicine.  Our insurance covers most of the treatment costs most of the time.  So we accept this "we don't talk about money" stance from our medical establishment. 

Dental insurance defines how much they'll pay in a given year.  The patient makes more decisions about what and how much dental treatment they'll receive, because they're making choices about more of their own money.  

So, as frustrating as it is to the dentist wanting to offer awesome treatment to their patients, dental insurance requires that we talk about money.  At my office, we talk about money before we start treatment so everyone is on the same page.  As much as I wish it weren't the case, money determines dental treatment options as much as anything.  

Why don't we have the same talk about medicine?  Why is health reform such a political hot potato?  I would suggest it's because we don't talk about money with patients.  Patients will make the best choices for themselves when they're given all the information.  I don't pretend to offer solutions to our health care problems, but I do promise to make sure you know how much stuff will cost in my office before we do it.  

Surprises are great at Christmas, not at the dental office!

Questions or comments?  Feel free to email me at:  I read and answer all of my own email and love to hear from readers of the blog! 

Predeterminations: how dental insurance companies save money…for the dental insurance companies(part 1)

Dental insurance companies make a LOT of money.  Even the non-profits.  The way that they do this is to pay out less in dental treatment than they take in from patient premiums.  Their goal is to take in more in premiums from their average subscriber than they pay out in dental fees.  There are a lot of tricks the dental insurance companies can use to create patient incentives to limit dental treatment.  The strategy I’m going to talk about in this post is “the predetermination.”

As a dentist, I’m excited by all of the cool and innovative treatment options that I can offer patients. Patients are sometimes excited by treatment options, but usually have concerns over the costs of treatment.

Let’s say I diagnose a failing filling with a new cavity underneath it.  I recommend that the patient restore this tooth with a crown before the decay gets any larger and causes a need for more extensive treatment (like a root canal, or worse…loss of the tooth).  The patient has to work through several concerns before they go ahead with treatment:

  • How much time will it take?
  • Can they work it into their schedule?  If so, when?  Will they need to arrange different rides for the kids’ soccer and football practices?
  • Will it hurt?
  • How much will it cost?  Will the insurance that they take money out of my check for help pay for it?

Often, my office team can help explain the procedure well enough and arrange the timing conveniently enough that it comes down to the $$$.  Kathy does an amazing job at predicting if insurance will cover treatments and how much.  But the insurance companies make it as difficult as possible for us to guess.   Often the patient wants to get a “guaranteed predetermination” of how much will be covered.  This is a huge opportunity for the insurance companies to save money for themselves.

Dollar signs.img_assist_custom


First, a predetermination takes time.  Even though we are completely connected via the internet, the insurance companies like to take a couple weeks to get back to the patient.  By this time the patient has long since forgotten about the decay (which is usually painless while it’s growing) under their filling and the patient didn’t make an appointment for the crown.

By making the patient wait for the estimate of how much the insurance company will pay for their specific treatment the insurance company keeps a certain percentage of patients from going ahead with treatment.

How do I know this?  I see patients every day that I’ve discussed treatment with who “slipped through the cracks” and didn’t complete treatment at the time we diagnosed a need.  Sometimes the timing wasn’t convenient for the patient, but often we have a copy of the “predetermination” sitting in the chart but no appointment was made.  This is the plan of the insurance company…and it often works.

Adding insult to injury…predeterminations aren’t binding.  If you read the fine print, in most cases the insurance can still choose to not cover the treatment.  I’m not going to say that happens often, but it can.

So, what’s the solution?

1) Make sure you trust your dentist’s opinion and that you believe they have your best interest at heart.  If you believe your dentist is trying to push treatment on you for financial gain you need to ask the dentist more questions or find another dentist.  Your dentist shouldn’t be annoyed when you ask questions…they should rise to the challenge!  It’s great if you trust your dentist’s judgement on their word alone, but they should be able to show you what they mean and explain all the treatment options, even doing no treatment.  If they balk at this…you should get a second opinion.

2) Make an appointment.  Kathy and/or Shelly can usually guess when any predetermination will arrive via the mail as well as a rough estimate of your out of pocket costs for most treatment.  Make your appointment for a couple of days after this.  By that time we can discuss any concerns you have and change our plans if necessary.  But at least you won’t have fallen through the cracks.

Questions or comments?  Email me at  I read and answer all of my own email and I’m always glad to hear from patients and prospective patients alike!  Also, keep checking back for the other parts to this series on dental insurance!  Part 2 will be published here.