This blog post is a reaction to the article "You and your dentist may have a bone to pick with Delta Dental" that appeared in the Seattle Times. Read the full article here.
Delta Dental is arguably the biggest dental insurer there is. From a provider’s standpoint, Delta Dental has the upper hand over new and old dentists and has for some time. If you’re not in-network provider with Delta Dental, they will issue any claim payment directly to the patient only. Obviously this can put dental offices in a situation where they charge a patient upfront or chase them for payment. In-network dentists get reimbursed directly by Delta Dental but we are subject to all sorts of limits, rules and cuts to benefits, year after year. From an administrative and billing standpoint, Delta Dental can be easy to work with due to quick electronic eligibility, claim submission and payment, but any cost saving efficiency is lost due to their efforts to stall or deny claims. Delta Dental is not the worst insurer (United Concordia wins the medal for being the worst dental plan) but Delta Dental is up to something and we’ve taken notice. It is interesting executive salaries are increasing as claim payments towards seem to be dropping.
Delta Dental is not the only insurer guilty of such tactics but it seems as though they are getting worse. Most dentists’ dream of the day they can drop Delta Dental altogether because of new limits, cuts in benefits and stalling of payments have gotten out of control. Dentists’ already take a cut of their normal fee for services in order to be a Delta Dental provider. Delta has improved and streamlined a lot over the years but only to help their bottom line. We still spend hours on the phone trying to adjudicate basic dental claims. Lastly, employers and human resource departments need to understand the real implications regarding dental benefits for their work force. Delta Dental claims it is the employer that determines the level of coverage-good or bad, not Delta Dental. It is our opinion that is partially true and that employers do not really understand the quality of plans. Executives, CEOS etc, could easily afford dental treatment without insurance but the often have top notch plans that are not offered to the regular employees. The point is some employers potentially have a blind spot when choosing employee benefits.
It’s that time of year again, the opportunity to renew, change, add, or upgrade your insurance. If you are a person who purchases insurance on the individual market, dental plan options will be somewhat limited. In most cases, individual dental plans outside of employer-based plans are not worth getting. If you are stable and only need routine cleanings and exams, paying out of pocket could be your best bet, and most offices will be happy to work with you. Those patients concerned about the unexpected can open a health account paid into (instead of monthly premium) for unforeseen dental circumstances. People who understand they need dental work and likelier to use their dental plan will only have about $1000-$1,500 in benefits to use along with co-pays and limits. Dental insurance, even great dental insurance, is somewhat of a discount card for treatment. It helps but in many ways is not always worth it.
If you have employer-based health benefits that include dental, this is your chance to upgrade to a PPO, add a spouse or dependent or set up a health savings account. Health savings accounts use pre-tax dollars set aside to cover out-of-pocket medical and dental costs. If you need $3,000 worth of dental work and your plan only pays $2000, then set aside an extra $1000 tax-free, which could help.
Switching to PPO
PPO plans are the best option when it comes to picking or upgrading a dental plan. It is the best option because PPO plans pay the dental office for completed dental work. Wouldn’t you want treatment from a dentist that is being compensated fairly? HMO plans offer ‘no cost’ or extremely low fees for services. Many quality services that normally are part of or included in PPO plans are not covered by HMO and therefore chargeable to the patient. There are many reasons why HMO plans are not good for the patient and dentists, and we will cover that topic in a future post.
Things to look for when evaluating or picking a dental plan:
- Make sure it is a PPO plan!
- The maximum yearly benefit of $1,500 or more.
- Waiting periods. There shouldn’t be any…But If there is a waiting period, it should only be applied to major services (12 months)
- Deductibles ($25-$100)
- Two or more dental cleanings covered per year. Most people need three or four.
- Implant coverage
- Effective date and plan year (Jan-Dec, June-June, Sept-Sept)
You can always e-mail email@example.com with a screenshot or information of your dental plan options for our manager to evaluate.
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