The Myth of Dental Insurance

Portrait of family keeping their hands one another at home

In my last blog I spoke of the inevitable changes that we will be seeing in dentistry. The dental insurance marketplace is one area that should be included in that discussion, if only because so little has changed, with the exception of how successful they have become in controlling the dental marketplace. I would estimate that 80% of our patients have some form of dental insurance, yet few really understand what this really means for them.

A quick look at the facts:

  1. “Insurance” is intended to help with catastrophic problems (i.e. The current flooding in the Mid-west, Hurricane Katrina, your home is destroyed in a fire, etc.)
  2. There is NO comparable “catastrophic” downside in dentistry!
  3. No dental insurance company has ever lost a nickel on a dental plan. There are so many deductibles , co-pays, and limitations that they can’t lose money! (Have you ever heard of a State Lottery or the Powerball Jackpot losing money?)
  4. In 1975 the annual maximum payout per person in dental plans was about $1,000. Today, 40 years later, it is still only about $1,000. The only thing that has increased are the premiums!
  5. In the average indemnity plan patients only see about 65 cents in return for every dollar in premium paid. The rest goes to the insurance company’s cost of doing business, salaries, profits, etc.
  6. Insurance companies are in the business of making money, not providing dental care. Providing dental care is only incidental to why they exist!

I could go on, but hopefully you get the point. We would be happy to discuss any concerns you have regarding dental insurance and I want you to know that we will do everything possible to maximize any benefits you may have coming to you. For those without dental coverage, I am happy to announce that we now offer our own “in-house” dental program to help control costs. Please ask us for details. If you have any questions in the meantime, you can contact me or the staff at my office, Dr. Laurence Stone in Doylestown, PA.

We’re always here to help.

Dental Savings Plan – Save on Your Dental Visits with an In-House Plan

Dental Savings Plan

I remember practicing in an office in Southampton in the 70’s before there was dental insurance on the East Coast. No one really knew if it was going to be a good thing or not. (Dental insurance had been available for about 10 years in California before heading east.) Well, now here we are almost 40 years later and honestly, I still can’t tell you if dental insurance has been a good thing or not.

I suppose if you had it through an employer and were able to take advantage of it, then yes, it was good for you. But in most plans there are so many limitations, exclusions, participating/non-participating dentists, etc. that it is sometimes difficult to realize any significant benefit.

That’s why we started our own “in-house dental savings plan” for those of our patients that don’t have dental insurance. For a fixed fee you are guaranteed to save on your routine cleanings, X-rays, exams and fluoride treatments each year. In addition, you are guaranteed 15% off ANY additional services provided here with NO limitations, exclusions, pre-authorizations, etc.

When you consider that there is no catastrophic downside in dentistry and that no dental insurance company has ever lost a nickel on a dental plan, you can begin to understand that just having “dental insurance” is no guarantee that your needs will be met.

You can read more about the program in the Insurance section of my site. If you would like to see how this program can work for you, just call the office (215-230-7667) and ask to speak to Laura, my Treatment Coordinator. See you soon!


Dental Myths Dispelled – Part 2!


In my  last blog we discussed the pervading myths on root canals, baby teeth and dentures. This blog will address even more popularly held beliefs that could not be more false. Welcome to dental myths dispelled, part 2.

4.  Dentistry is Expensive

Really? Compared to what? A friend once showed me a bill from her veterinarian to have her dog’s teeth cleaned. Not to denigrate veterinarians but it was a lot more than my fees! What’s really expensive is neglect. Not paying attention to proper home care procedures and failing to take care of problems when they are small and easily managed can be a very costly mistake. People often decry the fact that they don’t have a dental insurance. Insurance is actually Intended for catastrophic problems, i.e. your house burns down, you need a $100,000 triple bypass, etc. Dental problems can be more easily managed financially with proper planning and smart prevention. Don’t be penny wise and pound foolish!

5.  Dental Disease has no Effect on my General Health.

With all that’s been written in the media recently, I can hardly believe anyone holds this to be true anymore. Dental disease and periodontal (gum) disease in particular has been associated with pre-term low birth-weight babies, diabetes, and heart disease, to name a few. Think about it. Even in times past, when folks went to buy a horse, the first thing they looked at were his teeth! People instinctively knew that an animal’s health was related to its general health. Sir William Osler, one of the most forward-thinking physicians who ever lived, is quoted as having said, “The mouth is the gateway to the body.” More than that, the mouth is an indicator of what’s going on in the body!

6. It’s Normal to Lose Teeth as We Age

There are over 30 million people in this country alone that are completely edentulous (having lost all their teeth), So it’s easy to see why people might think it’s normal to lose teeth as we age. Fact is – teeth are lost as a result of disease, periodontal (gum) disease in particular, the number one cause of tooth loss in adults. In fact, periodontal disease is so widespread that it is said to be more common than the common cold! 80% of adults have some form of gum disease and gum disease causes 90% of the tooth loss in adults. Statistically a lot of folks may be missing teeth, but remember, teeth are lost as a result of disease. Disease is not normal. Health is normal!


Dental Insurance vs. Direct Reimbursement. Why you need to understand the difference.

Even before the specter of the Affordable Care Act we’ve often been asked questions about dental insurance and why we don’t participate or why a plan doesn’t pay for this or that. It’s really not that complicated. Dental insurance is a rigged game and I refuse to play. No insurance company has ever lost a dime on a dental insurance policy. Insurance is for catastrophic events: i.e. hurricane Katrina, a $100,000 triple by-pass, your home burns down, etc. There simply is no catastrophic downside in dentistry! Therefore…no need for insurance. Same for eye glass coverage.

What people should want, where possible, is a dental benefit program. The answer for this is Direct Reimbursement.

Never heard of it? That’s because there’s no money to be made from it. No money for insurance companies, brokers, or sales people!

How does it work? Simple. You or your employer set aside a certain amount of money each year depending on a predetermined limit of coverage and the patient can:

  1. See any dentist of their choosing (there are no participating/non-participating dentists)
  2. Have any procedures done that are needed (there are no covered/non-covered services)
  3. Pay the dentist his or her regular fee.
  4. Present your paid receipt to your employer who will write you a check, up to the predetermined limit for the year.

The benefits to the employer are great too:

  1. The employer gets the same tax write off that they would for an insurance program
  2. You get the same benefit for less or a better benefit for the same amount of money set aside. (Typically the average benefit with a dental insurance plan is 65 cents for each premium dollar paid. The rest is the insurance company’s costs and profits!)
  3. If there’s money left at the end of the year…the employer keeps it! It’s their money! (When’s the last time you heard about an insurance premium being refunded?)

Need more information? Just call or e-mail my office or the American Dental Association. We would be happy to help you or your accountant set up a Direct Reimbursement Program for your place of employment!