The latest technology and science in dental healthcare isn’t always inexpensive! While much can be done individually to prevent expensive problems, most people will eventually find it necessary to have some degree of dental care and will have to deal with the issues of dental healthcare expenses eventually one way or another. How this is accomplished is highly individualized from person to person according to their needs and often dictated by their abilities. Still, no one wants to be treated using cheap shortcuts, or antiquated technology or old science.
Prevention and good health practices always make the bill smaller. However, some mistakenly think that ignoring a problem or choosing a less expensive alternative is saving them money. There is more to the equation than what something costs in dollars and cents. Many people fail to consider the costs and impact their decisions have on personal confidence, career success and advancement, social acceptance, and personal health. Ignoring and down-grading treatment often costs more in the long run due to the high costs of re-treatments, compounded problems, and the consequences of inadequate and ill-timed care.
Regardless of how you look at this, the reality is that everyone has their own ways of valuing their dental health and their smiles. To be fair, everyone starts from a different place and with a different value system in making these judgments; some people save their teeth and others don’t!
Often in healthcare the conversation quickly turns to the issue of costs and availability of insurance. It’s an appropriate and necessary consideration, but too-often becomes the center focus of how many make their healthcare decisions.
There is no doubt that dental insurance has helped countless people to enjoy a higher level of health and well-being than perhaps otherwise would have happened. Since its inception, dental insurance has enjoyed a “love-hate” relationship with patients and dentists alike.
Over the past few decades the “insurance mindset” has conditioned many people to think that if insurance won’t pay for dental treatment then it wasn’t necessary in the first place and that they couldn’t or shouldn’t exceed their policy provisions. (This has given insurance companies tremendous power and has seemingly set them up as the final arbiter of your health - a position they relish, for obvious reasons.) Many people unfortunately yield their power over making personal health decisions to their insurance companies and regrettably suffer the consequences.
The notion that third-party coverage mandates limitations in dental healthcare could not be further from the truth for a number of reasons, the most important of which is that dental insurance itself has severe limitations of coverage including an annual maximum benefit cap. Given the meager allowances in benefit coverage (often in the $1,500 range), having or not having coverage is of minor concern when significant amounts of treatment become necessary.
Each person must decide for themselves what level of health or disease they are okay with having. In the final analysis it’s often a “values” consideration. After all - it’s your mouth! In reality, the time and cost and values questions must be resolved as dental health is just one more consideration in a long line of many expenses demanding your attention. This is especially true given the fact that all dental disease is preventable and that most of it could be avoided if avoiding it was important to the individual - as well as if dental health was elevated in importance when compared to other discretionary expenses that are not reimbursed by insurance such as vacations, gifting, TVs, recreation, pet food, hair care, etc.
Due to the important life-impacting and often life-taking consequences of dental and oral health, your dentist’s responsibility is to thoroughly evaluate your smile and oral health condition, and to offer an accurate diagnosis along with treatment choices and their comparative pros & cons. In the final analysis your dentist will allow you to make up your own mind as you understand the positive or deleterious consequences of your decisions.
Let's face it - nobody likes to be surprised when it comes to cost. Once you and your dentist have created your dental treatment plan (your “pathway” to your dental health and cosmetic goals) the issues of costs must be addressed. Your personal responsibility for staying healthy not only includes good prevention and proactive health practices, but it also includes finding a way to reasonably pay for the healthcare that has become necessary or is desired. Fortunately today there are affordable solutions for your smile and for your budget, including insurance, personal finances, and patient financing.
Insurance
Dental Insurance Companies are in the business to make money. To be profitable they must take in more money in premiums than is paid out in benefits and insurance claims. That’s how it works! That in part is the essence of the current healthcare debate. All insurance companies have policies and provisions in place to protect their assets and to meet the coverage requirements that were contracted for by those purchasing the care (usually your employer – as a benefit of employment). While they have no power to deny treatment, they can deny benefit payments, based upon policy provisions. If this matters to you, it would be well to read your policy documents or talk to your HR representative at your place of employment.
Dental insurance by its very nature is not “major” insurance. Medical insurance or “major medical,” is. Medical insurance is designed to cover catastrophic health problems. Not so with dental insurance.
In fact, dental insurance really isn’t “insurance” at all. Instead, it’s pre-paid dentistry. True insurance per se’ is about risk – and there is no risk when the insurance company limits their exposure or risk with an “annual maximum” of allowable benefits. Generally, dental insurance pays well for “routine” visits such as exams cleanings and fillings, and they pay poorly or not at all for more expensive care such as crowns, bridges, implants and cosmetic dentistry.
Dental insurance is not intended or designed to be a “pay-all”. Please do not be surprised when you realize that reimbursements are typically less than you might expect, especially for more comprehensive care.
The annual maximum for conventional indemnity insurance limits is generally between $1,000 and $1,500 for most plans. It’s amazing to realize that this is the same number that existed in the 1970’s when dental insurance first started.
Other forms of insurance coverage utilize PPOs (Preferred Provider Organizations) and other “closed panel” and provider network plans. Generally these plans only allow payment on or for specified procedures and/or will penalize or offer reimbursement at lower coverage levels if performed outside of their provider network or covered facilities. Again, this is a function of the benefits purchased and the contract entered into by the employer or persons purchasing the coverage. In all cases, by force of law, the insurance coverage must cover the benefits covered in the insurance contract.
Often, despite their best efforts to stay current with the new science and technology, insurance companies will not provide coverage for newer procedures and diagnostic services which are superior to older methods and will save money and better preserve health.
Because of the nature of the “business of dentistry”, it is easy to begin thinking of dentistry in terms of a “commodity” instead of a personal service. A commodity, like tuna fish or gasoline, can be purchased identically and equally from a wide variety of sources in the marketplace. Procedure codes have had much the same effect in medicine and dentistry – to equate a given service as the same regardless of who provides it.
The truth is that just as not all patients are created equal, so too not all dentists are created equal – nor is the care skill judgment and services they offer. It is all highly individualized and reflects the levels of training, experience and quality of materials used, along with the desires of each patient. Insurance and other procedure codes tend to normalize and ‘commoditize’ health services without regard to quality and individual patient needs and wants.
Remember that insurance isn’t right or wrong. If you have it, thank your employer. They will at least pay something! Just not everything! Regardless of whether you have coverage or not, the reality is that you’ll likely need to budget and cover your dental expenses one way or another. Due to the low coverage limits of all dental plans, how this is accomplished will be more a reflection on your values than on whether you have or don’t have the help of a third-party.
Patient Financing
Many people find it necessary to have the ability to finance needed dental care.
Information from various patient financing companies across the USA says that the average request for a dental loan ranges between $10,000 - $30,000. While this may not represent your situation, it does indicate something about how dental care is purchased and viewed by people across this country.
If you've been putting off dental treatment due to budget constraints, healthcare financing companies exist so that you can begin your treatment, and conveniently pay with low, monthly payments. This didn’t used to be the case. Prior to several years ago dental consumers had no financing options except to use their dentist as the bank, against better judgment. This practice although common, often puts your dentist in an awkward position and sometimes creates situations where respect and professional judgment are too easily compromised.
Health financing companies work in the same way as automobile financing companies work. Most people don’t pay cash for their car. Instead they take out an automobile loan, and make monthly payments for 3, 4 or 5 years or until their car is paid off.
A common objection heard by some people contemplating significant dental care is that they don’t want to go into debt or pay interest. They often fail to recognize that paying interest on financed care which stops disease and stabilizes oral health is usually much less expensive than allowing the problems to cause further damage and run up costs of unnecessary care later.
Some people ask or expect the dentist to personally finance their care and to carry their debt out of convenience or because their credit rating won’t allow them to borrow money. While some dentists may allow this (because they want their patients to receive needed care) it places the dentist in unfair and uncomfortable positions and often carries high risk to damaging the trusting relationship and continuity of care. Many people in this situation recognize that if they are not able to obtain financing due to poor credit, that it’s unfair to expect their dentist to be the unsuspecting lender and to loan them money.
With the many options now available in today’s modern world, including the kind help that often can come from family, there’s nothing wrong with financing dental treatment. The interest is much less expensive than waiting and allowing your dental problems to get bigger and more expensive.
Summary
In the end like most matters in life, how one pursues their dental care is a matter of individual choice. Dental problems are preventable. But when they occur there is almost always a way to solve them using a combination of creative effort, time and careful attention.
Your dentist will understand and respect your decisions. They should feel welcome and free to tell you the unvarnished truth about your true oral health conditions, and then feel comfortable in helping you understanding your options - which should always include the best care available. He or she will tell you about your risk factors and problems, speak honestly about your choices, and then once they feel you understand the consequences of your decisions, will stand back and let you decide what kind of health or disease you are happy with pursing and valuing.