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.
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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 firstname.lastname@example.org. I always answer my own emails!