So I got health insurance first. Now for the dental. I always thought it was a no brainer. Just get dental insurance. You don't want to pay for all this stuff out of pocket right?
But dental insurance doesn't work like health insurance. There is a cap. Usually capped at $1,000. The cap has remained the same for decades but monthly premiums have been steadily on the rise.
I had oral surgery a few years back. Insurance denied the claim the first 3 times, then they covered it. Denying it initially is a common practice to stall out payments (the longer they hold out, the more interest the insurance company can earn on your premiums). When they did cover it, I was capped at 1,000 and I had to pay 2,000 out of pocket. Not only that I had to now pay out of pocket for my 2 cleanings that year, because even though cleanings are 100% covered, because I had hit my max cap there was no more money to pay for cleanings. So that year I paid around 2,400 out of pocket. Luckily dental insurance came free from my work. Now if it didn't and I had to pay premiums myself, I would have paid a total of 3,020.40 that year.
It was then explained to me by my oral surgeon and dental office that dental insurance is not like health insurance. It's not like any other insurance actually. It's the opposite of most insurances. Instead of having a deductible, and once you pay your deductible the insurance covers everything else, dental insurance kicks in from the beginning but will only pay for a limited amount. Sometimes dental insurance even has a 50 dollar deductible even though it caps out at 1,000 max coverage.
The calendar year max coverage is anywhere from 800 - 1,500. That is if you have a decent plan. If you go with a really inexpensive one, they will partially help you pay for certain routine procedures.
So if you get it through your work, great. If you don't, it's not just a no brainer as I once thought. You have to do the math. If you have a family or you have a lot of dental problems, you may really need insurance. For non-family individuals who have moderate amounts of problems, you may be surprised once you do the math and read the fine print.
So I have a great new dentist. She also told me to do the math. I read a lot of material online and read the fine print. Here's an interview with another dentist that was on Money Talk News:
My dentist does all the cleanings herself, only uses the safest materials, and will not put any metal into my teeth. That was very important for me as I did not want any metal or mercury inside of my head at all. Neither does most educated people. Even outside of health risks, you don't want a silver cap or crown in any visible teeth.
She charges $119 for the cleaning and check up (including the x-rays). She also takes all standard dental insurance. She does everything by the books, so whether I paid her or insurance pays her, she will collect the same amount of money. So some people were trying to imply that she told that dental insurance was not a good idea because she would make more money if I paid her in person instead of insurance. Not true. If anything its common practice to milk insurance. I also need 3 fillings which are $235 each.
How Many Cleanings Do You Really Need?
So most people think you need 2 cleanings a year. Not true. Any good dental school and any good dentist will tell you you need 3-4 cleanings and check ups per pear. So where did 2 come from? Insurance. Dental insurance will only pay for 2 cleanings and check ups per year.
But my dentist must be lying right? She just wants more money from me? She does all her own cleanings. She's going to work 50 hours a week regardless of whether I do 1 cleaning a year or 4. So will any other good dentist. If I cancel an appointment it will instantly get replaced. I tried to see her in November and I had to wait until February to see her. She's that busy and there's that many new people trying to see her. So whether I come in once a year or 4 times a year, she will make exactly the same amount of money. Actually a cleaning is the cheapest procedure she does so she would be better off putting a more expensive procedure in my time slot.
I get it. I'm a personal trainer and performance coach. I tell people to come in 3 times a week if they can but if they can't it's up to them and their schedule. But whether they do or not, I will work the same amount of hours every week. Whatever time slot they don't take, someone else will end up taking it. I just offered it to them first. That's it. It really won't affect my bottom line (offering it to them sometimes hurts my bottom line). For a less busy trainer it will, but not for me or for my dentist. Actually a lot of dentists.
Why 3-4? Well let's say you go to the dentist every 6 months. Brush twice a day, floss daily, avoid bad foods, don't grind your teeth. Somehow though a cavity forms, or you need a root canal, or you have some other issue. How did that happen? Because you only go in once every 6 months, they give you some tips, pat you on the back and wish you luck. You are basically watching your own teeth, not them. Why? Because they see you twice a year. As an avid martial artist, who always has to wear protective mouth guard, I constantly have to be on alert about damage to my teeth. So it's extra important for me to go in often. And lifting and fighting has actually been wearing down my teeth because I bite down on my mouth guard so hard.
When you see them more often, they can monitor your teeth more frequently and be on top of any issues before they happen. I have been wary of bone loss on my gums ever since I had braces. I had to have surgery once already and they said I may have to get another. Well I need to save my gums as much as I can with prevention, and to do that I need my dentist, not an untrained person like me to be watching them. She takes photos of my smile to track changes.
So let's do the math already. Let's assume you go in just 3 times a year for cleaning and check up. And let's use my dentists rates (which are pretty inexpensive) as the standard model.
Without Insurance:
3 cleanings 119 each = 357
3 fillings posterior nonamalgan 235 each = 705
Grand total = 1062 for the year.
With Insurance at 30 dollars a month:
2 cleanings covered = free
1 cleaning = 119
3 fillings posterior composite resin fillings 235 each = 705
Monthly premiums at 30 = 360
Grand total = 1184 for the year.
Difference = $122 cheaper without insurance.
The Fine Print
So here is why the difference and why the fillings were not covered. Every insurance coverage I found only covers fillings in the anterior (the front teeth) for composite. Composite is natural nonmetal fillings. For any of the back teeth (posterior), it only covers for metal fillings (amalgam). So either I would have to get metal fillings which I do not want, or they wouldn't have covered my fillings anyhow. Read your insurance coverage for yourself or call your insurance.
That is with a good plan. If your insurance plan is around 20 dollars, they will only partially pay for your silver fillings. The only reason they will pay for composite fillings in the front teeth is because no one wants to show any metal in their smile.
What about crowns? They will only pay for metal crowns or porcelain fused to metal. If those kinds of things aren't important for you, then by all means go get silver or gold or amalgam fillings. For me there's too much evidence that this is detrimental to your health.
Lets do the math again just for cleanings.
Without Insurance:
3 cleanings 119 each = 357
Grand total = 357 for the year.
With Insurance at 30 dollars a month:
2 cleanings covered = free
1 cleaning = 119
Monthly premiums at $30 = 360
Grand total = 479 for the year.
Difference = $122 cheaper without insurance.
Then people will argue there's plans that are 18 dollars a month. What about that? Yes plans range for individuals from $18 - 60 dollars a month. The cheaper insurance either has a very low cap or has no cap and is super restrictive on what it pays and how much it pays. And you still have to pay for the cost of the precious metal for fillings and crowns.
Now if you get a really expensive work done, you will still pay out of pocket like I mentioned before. And for the type of coverage I had previously, with Blue Shield I would have to pay $51.70 a month.
Even if I save money with insurance one year because I had a lot of major dental work. What about the next year? It will even out that I lose money with insurance. What about the year after that? What about the next 5 years? Especially when your dentist office offers interest free payment plans, and sometimes direct insurance through your dentist at a much lower premium.
Being a Series 7 licensed broker, I always have to crunch numbers. It's what makes me such an effective trainer. And after doing the numbers, dental insurance just doesn't make sense for me. Not only that but a lot of plans are restrictive on what dentist I can go to. I want to pick my dentist, not have my insurance pick for me.
So let's do the cheap numbers for those who pay 18 a month.
With Insurance at 18 dollars a month:
Monthly premiums at 18 = 216
Let's be honest here. Most likely someone who pays this little will probably not walk into the dentist office at all that year.
Without Insurance:
Monthly premiums = 0.
Because you aren't the type of person to go into the dentist anyway you will pay the dentist office nothing.
Difference = $216 cheaper without insurance.
If you have to have major work done every year, then it's worth it but it probably also means you are not going in enough for check ups. If you have a family and kids, it's also a good idea. But for individuals or even married couples it doesn't make sense. It's cheaper to get separate dental insurance plans than to get one jointly. Go figure.
Go ask your dentist and see what they say about insurance.
About the Author:
Sam Y. is a Master Personal Trainer, Coach, Certified Nutritionist, Performance Enhancement Specialist, Corrective Enhancement Specialist, Pilates and Yoga instructor, and holds multiple certifications. He is also an avid Martial Artist, training in Brazilian Jiu Jitsu, Kickboxing, Boxing, and MMA. He is also the author of the popular fitness blog All Out Effort as well as the popular martial arts blog Inner BJJ. You can find him in the Los Angeles area personal training his clients, or at home annoying his wife, or on Facebook at his personal fitness page.
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Without getting into this insurance is good or bad debate; as a dental hygienist I have to say that you are wrong on so many levels.
ReplyDeleteAmalgam restorations are stronger than tooth colored restorations which is why they suggest them for posterior teeth. The amount of chewing force used when masticating makes them less likely to crack or wear away. Not to mention, the only likely hood of ingesting any mercury from these fillings are because of removing them, not putting them in.
As for cleanings, whether you get them from a Dentist or a Hygienist, they should be charging by time used, not a base number. I suppose it would benefit people that have poor oral self care and have lots of calculus (tartar). If you are maintaining your teeth properly ie. flossing properly and brushing properly you wouldn't have to pay that much for a cleaning, nor should you have x-rays done every visit.
Funny how you're so concerned about having metal in your head, but you aren't opposed to them aiming a x-ray beam through your head every visit, which is by far more likely to cause problems than amalgam restorations, your opinion is pretty much purely cosmetic.
As for a cleaning example, when I go in for a cleaning because I brush and floss properly, I never have calculus (tartar) and it only takes 1/2 to 1 unit of time to clean my teeth which equals maybe 15.90 - 31.90, plus a recall exam which is 25 bucks.
Also, part of a dental professionals job is to educate the public on maintenance and prevention, it would be ridiculous to think for one minute that she isn't trying to make money. It's a business and they make money on return customers.
Having a lot of decay or calculus has nothing to do with recall visits, if you aren't cleaning your teeth properly and eating properly, it doesn't matter if you go to the dentist every month, you'll still have decay, you'll still have calculus, etc. Biofilm (plaque) is bacteria that lives in your mouth at all times, some are good bacteria, some are not. Brushing and flossing properly removes biofilm from your teeth, under the gum line, and on your tongue. If you don't brush and floss properly, biofilm causes your tissues to be irritated, inflamed and bleed which is gingivitis, this is reversible if you start to clean your teeth properly, if you don't biofilm starts to react with the minerals in our saliva and starts to calcify or harden after 2 days, after a week the process of calcification is pretty much done and you'll have to have it removed in the dental office, if you leave it, that's when you start to get periodontal problems, eg. bone loss.
So all I have to say to you is that if you have good oral self care, brush and floss properly and don't have any kind of disease that causes trouble for your mouth, you won't have tooth decay, you won't have periodontal problems, etc.
I'm not saying you shouldn't visit your dentist more often, because you should. They can catch things before they get worse, but you are the person affecting those tooth problems. Also they are typically the first person to detect certain cancers or systemic problems, even if you don't have teeth ie. have dentures. But maybe next time you go to see this dentist, get them to show you how to brush and floss properly and maybe you wouldn't have had to go back for 3 fillings and have bone loss. :)
Great insight!!!
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