Dental Insurance: ‘Scam’ Or Not, Why You Probably Don’t Need It And How It Often Leads To Problems
Going to the dentist is a necessity. But dental insurance? Not so much.
Dental insurance is a relatively recent consumer phenomenon that exists primarily in North America. The industry sprang up almost completely overnight due to large American companies who decided to begin offering dental insurance as an extra benefit to their employees, in the hopes of looking more attractive. In fact, Delta Dental is almost single-handedly responsible for creating the dental insurance industry back in the 1960s, when they began partnering with labor unions, military and government organizations, and private corporations, in order to offer dental coverage plans.
- See also: Here Is The Exact Letter I Used To Get Back A Security Deposit In Full From A Hostile Apartment Building
In contrast with other developed countries – such as those in Europe – dental insurance in the U.S. is completely separate from health insurance, and is considered an “add-on” benefit that many American employers offer in conjunction with their health insurance, but usually under a different brand. For example, a company may have “group coverage” health insurance for their employees through the Blue Cross / Blue Shield network, and might offer additional dental coverage through an organization like Delta Dental. In many cases, employers offer dentals plans BUT DON’T COVER THEIR COST, meaning that its an out of pocket monthly fee passed on to their employees.
Despite there being no such thing as “vision insurance” or “chiropractic insurance” in existence, the self-created, industry-driven anomaly that is dental insurance continues to grow bigger (and seedier) with each passing year. And unless you’re an MMA fighter, cocaine addict, or have a rather large family, buying dental insurance is almost always a waste of time and money.
Monthly Payments Exceed Typical Costs
Many people have unreasonable expectations of insurance; they believe that by paying into an insurance plan, all of their visits to the doctor, dentist, or otherwise should be free of charge. Not so. The main purpose of insurance is to protect you in case of an emergency which may land you with massive bills – for example, breaking your leg.
Ergo: unless your lifestyle presents serious risks to your oral well-being, 99% of people only need a basic dental cleaning a few times a year, meaning that separate dental insurance is rarely a necessity. In fact, even if you HAD a “dental emergency” the truth is that its probably not even covered by your dental insurance (see more information below). Even the U.S. Senate is contributing to dental insurance alarmism, due to the fact that Medicaid holders do not get dental coverage. Bullsh*t. Even if more people DID get dental insurance, it wouldn’t save most of them any cash at the end of the year because the monthly bills usually exceed out-of-pocket costs…
On average, the maximum annual payouts from dental insurance plans are only $500-2,000 per year, a figure which hasn’t changed since the 1970s. Adjusted for inflation, dental insurance plans should be paying out between $4,000-8,000 a year by now, according to MarketWatch.com. Instead, payouts remain minimal, while typical monthly fees of $30-60 per person add up to $360-720 per year in real costs, yet somehow only tend to cover 2 free basic cleanings each year. Oh, and if you want any “special” dental work done, such as implants, crowns, or other work, dental insurance plans typically won’t even cover those items until a few years into your coverage – and even then, it only covers 50% of certain procedures, OR LESS, in many cases.
Open Invitation For Insurance Fraud
Now, I know what some of you are probably thinking: “Well, maybe dental insurance is a ripoff… but I get it free/cheap from my employer, so I might as well keep it.” But even when insurance is FREE, it invites massive consumer fraud that comes with any other type of insurance. Except, for some reason, dentists seem especially prone to it:
- Unnecessary, dangerous procedures to hike up insurance billings
- Fraudulent inflated billings (i.e. lying to your insurance company)
- Phantom treatment on patients who aren’t even in their office
- Forcing you to get “deep cleaning” a.k.a. scaling/root planing
- Random charges for things like antibiotics or equipment
As a clueless young college graduate in California, I myself was a victim of “deep cleaning” fraud. At the time, I had Kaiser Permanente (HMO) health insurance with a Delta Dental add-on coverage package. Scanning the Kaiser online database for an “in-network” dentist, I showed up to their office for a basic cleaning when the dentist convinced me that my gums were unhealthy and that I needed immediate scaling to be done. She assured me that it would be mostly covered by my insurance, and tried to schedule me for a total of 3-4 additional visits to her office. After the 2nd visit, I attempted to ask her what would be done at the 3rd visit. She became angry and shouted at me that she “was done talking to me” and would “see me at my next scheduled appointment.” Well, needless to say, I didn’t return to her office, and soon figured out she was attempting to overbill my insurance plan on root planing procedures that I didn’t even need!
Besides the obvious risks to your own personal health, these shockingly common practices can also have the side effects of exhausting your annual payout limits and increasing your dental premium payments, among several other outrageous situations.
It’s no surprise, therefore, that companies like AFLAC, Delta Dental, and Encore Dental are regularly called out on the internet for their dishonest sales pitches, in which they promise customers things like free dental cleanings, coverage of advanced procedures like crowns and implants, and other false advertising that is ultimately a complete scam.
Finding A Dentist Becomes More Difficult
T. M. Bridgeland, a writer at HubPages who used to work in customer service for dental insurance companies, explains why in the end, finding a dentist is MORE complicated AFTER you have insurance (something I also experienced):
There are lots of details, of course, such as In Network or Out Of Network dentists. In Net means the dentist is under contract not to charge over a certain fee for each service. In Net is usually cheaper. So get your routine work done In Net, and normally you will pay very little or nothing for it. You may also get reduced prices on major work.
Out Of Network dentists’ charges are not controlled by the insurance company or the network. The dentist can charge any price he pleases. Some Out Of Network dentists may actually charge less than the network price, and be cheaper for you than In Network. You have to do your homework before going to the dentist. Find out if he is In Net or Out Of Net, and ask him directly how much it will cost before you go. They don’t like to tell you, but you are the customer. Be polite, but insist. Would you get a haircut if the prices were not marked?
As in the case with many doctors, dentists who have built a business model around getting a stream of customers directly from an insurance network are highly unpredictable as far as quality and honesty goes. And why should they be? They don’t give a damn about customer satisfaction or even Yelp reviews, because they will keep getting more business from being one of the only “in network” dentists in their area.
That is, dental insurance is getting you a dentist who relies less on reputation, is probably charging more for their services than others, and is possibly committing some form of insurance fraud on a regular basis.
Ultimately, it makes more sense in most cases to simply put a few hundred dollars away in a “dentist” fund each year for basic cleanings. Then, find a local dentist with a good reputation and reasonable prices who doesn’t require $500 worth of “mandatory x-rays” before you can get your teeth cleaned.
- See also: Dental Discount Plans: Instead Of Buying Dental Insurance, Consider A Discount Membership Option
If you have a large family, or members of your family will be needing braces or significant orthodontic work, however, it may still be worthwhile to check out family dental insurance plans. (As with any medical insurance, watch out for pre-existing conditions, such as missing teeth, that are usually not covered.)
Or better yet, check out one of the many new “dental discount plans” that are popping up all over the place, which typically have a low yearly membership fee in exchange for greatly discounted dental procedures in your area.
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A person should pay a monthly / yearly insurance rate, factored by customer pooling and age brackets that matches to general rates of surgery. Cavities far more common in older vs younger. And share the burden. And have 100% coverage on all check ups, cleaning, filling, surgeries, and things that are not cosmetic. Industry needs regulation and fraud monitoring. Teeth Whitening, and braces for adult teeth (not children’s teeth) are cosmetic. Dentures for those without teeth / not cosmetic.
Cosmetic should not be covered in insurance at all. Price gouging is part of insurance, and dental practice. Dentist should go back to the roman days when they cut hair.
I,just used my Delta dental for the first time having paid 511.00 in premium payments and they denied my claim for an emergency extraction and I paid 1.00 a minutes for gas and they paid 20.00 wtf? What part is the insurance and savings the fact AARP backs and promotes this coverage to those on a fixed income is criminal. Their fraud department needs to investigate Delta Dental they were to pay 50% . I paid 179.00 at the visit and then got a bill for 114.00 due to the dentist additionally. Why? This sucks and I feel tricked by AARP approving these practices. I will be cancelling it as soon as possible.
Going to the dentist in the usa in a complete roberry , prices are inflated not worth it , there 8 billion people on the planet not every body pays us prices and not every body is teethless. Exaple my kid needed braces in usa is $7 thousand dollars in with insurance you end up paying $5 thousand , in south america like argentina , brazil , colombia etc is only $500 dollars astronamical difference , you know why? Braces need tightning every couple month or three plus the wire is very common to snap and have to be replace so you can not travel 3 or 4 tines a year for that and they know that thats why we get robb yup its a robbery. Same braces same quality everything . so dont believe you get what you pay for , its not always true
If you compare American vs Any other country you will see who cares about teeth.
Um, there IS vision insurance. I carry it from my job, so your statement that vision insurance doesn’t exist is inaccurate.
Did this author mean it’s not available by itself and is grouped into dental plans or another source of insurance plan?
As a dentist who started practice in the 70s, I can say that dental insurance was a driving factor to provide care and Chang societal attitudes toward dental health. Our parents and grandparents believed in a world where losing teeth and dentures were an inevitability. That’s no longer the case.
However back in the 70s ,$1500 /year with a $50 or $100 deductible was a great benefit when a crown cost $135 and gold was used was only $35 an ounce.
Today, that benefit can be used up on one molar root canal procedure or a single crown. Deduct your cost for subscription annually and you end up netting very little as a benefit. Though as pointed out, there are some circumstances that it still makes sense.
Why reform hasn’t happened, I don’t know. Why the mouth is not considered a part of the body under medical insurance, I could never understand. The best way for a family to get great dental care is rooted in three things.
ONE : parents set the example and join kids in brushing and flossing daily, morning and especially right before bed. That will prevent 90+% of all dental disease. Throw in a professional cleaning twice a year and you’re set for life in most cases.
TWO: save monthly for contingency situations like breaking a tooth or orthodontic care. Misaligned teeth are the number one contributer to lots off bigger problems down the road. A good smile will get you farther in business and relationships and build greater self esteem and confidence.
THREE: Don’t let little problems become big ones. That cavity you ignore, become the hot/cold sensitive tooth that you ignore that becomes the tooth that needs a root canal, that you MAY have done, but never return for the crown because it doesn’t hurt any more… Which then breaks because it’s now brittle, and it has to be extracted; and now to keep your bite from changing leading to other problems, beginning a cycle of dental decline you need a the unit bridge or implant and crown…. And then you blame the dentist because his/her work didn’t last.
It’s that simple. Brush, floss and get a professional cleaning with exam, save for contingencies, take action early. That’s it. Short of an accident, genetic problems, oral cancer (don’t smoke or chew) your needs for more extreme dental care should be minimal.
Maybe that’s why dental coverage is so weak… It’s mostly in the patient’s control and preventable.
Only people born with rare conditions of amylogenesis imperfecti or dentinogenesis imperfecti are born with bad teeth…. And those are very rare. You can use the excuse bad teeth or soft teeth… those just don’t exist as real condition out side of the two rare conditions I mentioned. What there are , are bad habits and soft priorities.
I call BS my cousin is a dentist and he’s tried everything to save my teeth. Part of it steams from the abuse I went through in my youth, but the main factor is that the PH of my saliva, (just like my mother’s who had to have dentures at age 20) is too high so my teeth bath in acid no matter how often I brush etc.
couple that with an archaic dental insurance system and once I turned 18 I was fighting a drastically losing battle because $2k a year even the rural area I live in isnt enough to take care of what I need.
Right now I’m perched precariously between life and death because of an infection in a wisdom tooth. A tooth I “have” to see an oral surgeon to remove and with it’s not currently infected but just as damaged twin it would cost me just over $4k to get them removed to save my life. Which for me since a motorcycle wreck (caused by a driver using a cell-phone) caused me to become disabled. That $4k is four months income and my children need to eat, be able to have daily needs etc.
my youngest has the family curse of acidic saliva but her dentist is sealing them. Something that was never offered to my mother for me because of dentist stuck with the archaic thought that only a couple diseases led to a predisposition towards bad teeth.
Drop a tooth that is in perfect condition in any acid and even in the lowest PH above saliva it will erode steadily.
How many people must suffer like I have/am? How many more must die from lethal infections before we get change to this broken system? If you have a heart attack you go to ER and they save your life regardless of your ability to pay. If an infection in a corrupted tooth is spreading dangerously though, they’ll just give you antibiotics and send you off without fixing the cause.
America needs emergency dental.
Oh and I signed up for a donated dental program to get this corrected, but they dropped my case because I sent them an email to update them when I had my uppers removed (per their request).
I respect that you are a dentist and you have to adapt where you live but a concider dental orices in usa a complete robbery prices are inflated totally . i posted a exaple my kid needed braces it was $ 7.000 with insurance discount ended in $5.000 in my country south amrica same braces same quality with colour as you wish tightnibg every 2 or 3 months as needed rhe wire snaps maybe never maybe 3 or 4 times per year everything replace the same job is only $500 us dollar yes only five hundred . but dentist here in usa kniw that you can not travel 3 or maybe 4 times per year just to adjust or replace snap wire so thats why they charge so much , any poor kid in south america has braces if needed i find it an embarresment that in the usa is so costly and usa dont get the materials from mars its the same thing anywheres , and that its just one sample . in south america you are never charge for consultation or x rays here its the first thing you get charge for , root canals , post , build up core , porcelain crowns no metal under venners ets is only 25% maybe 30% of what you pay here and its not always true that you get what you pay for iv done myself a complete smile make over hollywood style i mean complete for under $7.000 here they cuoted me $32.000 and thats on the cheap side in california probably more. , see here its depend where you live in south america is control by the state if you charge more then everybody a dentist has to shut down , anyway just wanna give my point of view i know its nit going to change but as long they dont get my money im ok with that. Best regards
Yeah, the times before fluoride. What a rant man.
This article is completely inaccurate. I am not saying that the author is trying to misinform anyone….but I definitely believe that the author has been misinformed or made a conclusion based upon very little experience. YES, there are plans out there that may not be very beneficial for certain patients….but most patients save thousands with dental insurance. I could list a ton f reasons but I will give you just ONE to sit and ponder on. Lets say you need your wisdom teeth out and you don’t have insurance…then your looking at about $400.00 per tooth (Depending on where you live) for a total of $1,600.00. And I’m not including nitrous or sedation or anything else to keep this example simple. Now let’s say that you DO have dental insurance, and they pay 80% on oral surgery (which is pretty standard)…they would pick up $1,280.00, leaving you to be responsible for only $320.00. NOW lets say that you have a PPO dental insurance (preferred provider) and you make sure that your dentist is a PPO dentist…this would mean that not only will insurance pay 80%, buy your dentist LEGALLY can not charge you more than a certain fee set by the insurance company. Insurances set fees are usually 25%-50% less than the doctors fees. So now you are looking at 4 extractions that cost $250.00 each for a total of $1,000.00. Insurance will pay $800.00 and you will pay $200.00…..so I’m not sure how anyone could say that is a bad deal. Now lets play devils advocate here for a moment and throw in a 1 year waiting period before insurance will pay on those extractions. MOST states require that the doctor still honor the insurances allowable fee even if insurance isn’t paying a portion yet. So simply having the insurance brings the extraction fee down from $400.00 to $250.00. This means that you still save $600.00 even though you have a waiting period….AND you will get 2 free cleanings that first year as those are ALMOST always exempt from the waiting period. The average cleaning and exam without insurance is about $150.00….so unless you are paying over $900.00 a year for your dental insurance…this plan still makes sense and is a great benefit. I know TONS about insurance….if you have a question and want some realistic advice about pros and cons I’d be glad to help.
You’re assuming 80%? Really? Wow I wish I could afford your example of insurance. Most typical only cover 50% and only on what THEY consider needed. If you need those teeth pulled, great, you actually save a bit with insurance, but since many of us don’t need those things, it is for cleanings. And since most cleaning, on average, work out to be about the same or less than any payments you make for a standard appt, you are better on average just paying out of pocket and preventing the major things that insurance would be any type of help with. However, you are still looking at thousands of out of pocket if you need things like partial, pins for those partials, which most insurance doesn’t cover etc. Most things that you really need when things go wrong aren’t covered. Trust me on this as I have been dealing with trying to keep bad teeth fixed for YEARS and the insurance just runs me around when the dentist tells them that my wife needs this or that. They refuse to pay because it isn’t absolutely needed. And dentures, forget it.
Cost of extracting Wisdom Teeth are covered under Medical Insurance, performed by a Maxillofacial surgeon. Usually NOT done by a dentist OR Oral surgeon.
Wish I had read this article and others like it before we bought dental insurance from Delta. Here is some free info to you that cost me hundreds of dollars. Delta wont pay for anything other than a cleaning (minus your deductible) until you pay premiums for 6 months and the service cannot be rendered until exactly 6 months or longer after your policy becomes effective.
Delta Dental is phony insurance. You save nothing with them, even if you have an emergency. In fact if you have a dental emergency, you are screwed because Delta pays your doctor a flat fee and he has no inclination to work on your mouth. The fees will be impossible. Delta Dental is totally worthless.
Hello, My DELTA Dental Ins. I have had through my company will expire soon. I will need to go on my own individual ins. With them. I am totally confused about DELTA. Should I pay premiums,or take the risk and go without? I checked with Physicians Mutual,it isn’t much different. THEY start in 3 months,not 6.
What would you advise?