The Problem with Dental Insurance

As if there was just ONE problem LOL…Dental Insurance gets more confusing every year. The main thing to remember is that insurance companies are in business to make money. That means they have to take in more money than they pay out. One of the biggest ways of doing this is by delaying payment. Let me give you a couple real-life examples.

A patient came in for some fillings in November of 2017. Claim was submitted electronically the next day. Legally, insurance companies have 30 days to pay a claim so twice a month, we print a report and call on any claims that are over 30 days. On this particular claim, insurance said that they did receive it and payment was sent. I waited another two weeks but no check showed up (1st delay). I called again and was told that I would have to wait 30 days from the date the check was issued to place a check tracer on it (2nd delay). I called a third time to get a check tracer placed. I was told they would have an answer for me in 7-10 business days (3rd delay). I called 2 weeks later and “no record” of me calling was noted from the previous calls; no check tracer was placed on the check (4th delay). I won’t bore you with the blatant neglect from this insurance company, but it is now January of 2019 and payment has still not been received. HOURS of salary were paid to our employees for a claim that should’ve been handled in 30 days!

Another problem we see continually is when an insurance company gives us a breakdown of patient benefits, and it says a particular code is a covered benefit. The patient has the treatment done, and the claim is denied (1st delay). More supportive information is sent to insurance for an appeal and they say it’s never been received (2nd delay). We send the information again and receive a 2nd denial on the appeal (3rd delay). We get the patient involved who calls the insurance company and is either told, 1- we never received an appeal from your dentist, or 2-the claim has now been re-reviewed and is in processing. Months it takes to play these games with your insurance. Two years ago, one company got so bad that we had to drop our “in-network” status!

Did you know that even with a preauthorization for treatment, they can still deny a claim?!? Being in this business for the last 25 years, I have seen a drastic change in coverage and not in a good way. The reason we buy insurance is to avoid paying thousands of dollars when a serious dental problem occurs. The company protects itself by setting deductibles, exclusions, waiting periods, and annual maximums that limit your coverage so much, you still pay most of the fees for any significant problem. As if that isn’t bad enough, the company counts on 30-40% of those who pay for coverage to not use any of it! Worse than that, most of their policy holders do not use their entire benefit (that they paid for). Since your premium cost is hidden in your payroll deduction, you do not even realize you are losing even more of your money!

That is why here at Summit Dental we offer our own membership plan that helps you keep regular appointments and catch little things before they become big things. We also offer financing plans to help you afford the care you deserve. Give our office a call to discuss which plan is the right plan for you.