With all the recent news surrounding health care these days I thought I'd throw my two cents in on dental insurance.

What you think you have in the form of dental insurance isn't really insurance, think of it more like a coupon. Before anyone gets mad at this analogy, let me explain what happens when you use your dental benefits.

As a dental office, we submit procedure codes to the insurance company for the services performed during your visit. Each procedure code has an associated fee. When the insurance company receives the claim one of several things happen:

The claim is conveniently lost, which delays payment for approximately 1-3 months on average.
The procedure codes are reviewed and some interesting things happen:

If the dental office is "In-Network" or in the PPO or whatever you want to call it, all the fees are reduced by an arbitrary amount and the claim is paid on a percentage of the reduced fee. The procedure code may be changed to an "alternate benefit", often at a further reduced fee. The remainder of the reduced fee may sometimes be billed to the patient, or may be required to be written off by the doctor.

So for example, you need a filling on a back tooth. Current standards of care are a bonded tooth colored restoration, let's say my charge is $150.00. Most insurance companies don't allow full coverage for tooth colored restorations on back teeth, so they change the procedure code to that of a silver filling, which they feel is only worth say $90.00. The insurance company looks only at that number ($90.00) when looking at your particular benefits which pays 80% for fillings (90 x .80 = $72.00). I am then allowed to charge the remainder up to the "alternate benefit" (90 - 72 = $18.00); which is why I still send a bill or try to collect an estimated copayment at the time of service.

At the end of the day, the insurance company found a sneaky way to only pay 48% on your treatment instead of the 80% they say they will pay in your benefit handbook. And as the cost of doing business with said insurance company and being in network, I am required to write off $60.00, or 40%. This is what I mean when I refer to dental insurance as a "coupon".

If you're still reading this, thank you. This kind of thing happens all the time with insurance. With some reimbursement schedules I can't even do certain things, like dentures or bridges, because my lab bills are more than what they would pay.

Running a dental office, or any small business for that matter, is expensive. Overhead can only be reduced so much without sacrificing quality of care, which I am unwilling to do.

I'd like to hear what you think. Let me know what I can be doing better or differently at your next visit. Thanks for your time,

Chad Versluis