Having been a dentist and in the dental world for the past 15 years, I have not had the pleasure or the pain of having to seek, find or understand dental insurance from a patient perspective. I’ve never had to research or make decisions about which plans to choose and why. I’ve never had to worry about waiting periods, restrictions, coverage limits, pre determinations, denials — and the list goes on.
As a dental patient, I have been blessed to have not had the joy of dealing with the dental insurance headaches as others have had, I’m sure. As health insurance has changed, some aspects have dental insurance have already changed. As of now, you must have dental insurance for your child if they are under the age of 18. So I, as a dentist, now have the smallest taste of what that journey is about when shopping for dental insurance. This is the first time I have questioned the system as a dental consumer and thought to myself, “this system does not make any sense.”
As a dental provider, honestly, I think I am an excellent dentist that puts the patient’s wants and needs above anything else. That includes the quality of dental care and the experience as well. We all know most people don’t want dental work, but it’s a must and a need. But, I have noticed that over the past 10 years treating patients at Highland Park Dental, I have been spending more and more time away from patients and having to battle, fight and appeal insurance claims. I have seen and heard every excuse from insurance companies as to why they won’t pay a claim or why they won’t approve a procedure. To be frank, it sickens me. Don’t forget that insurance companies are for-profit businesses. How do they profit if they pay out too many dental claims? Why is it that a dental insurance company is trying to determine how, what, when and why you receive dental treatment?
There are millions of people out there paying for dental insurance, on average $370.00 per year per person. Most people don’t use any of this except for maintenance cleanings and exams. Then, there are some that unfortunately need dental care beyond the normal cleaning and maintenance. If this is you, you will run into yearly maximum limits of what your dental insurance could pay. Once you hit that maximum, the remainder of that balance is paid by you, the patient, 100 percent. So let’s say you come in for cleanings twice a year and your insurance covered each visit at 100 percent. Then, at Christmas, you break a tooth on your favorite peppermint bark candy. You now need a root canal and a crown because the tooth broke so badly. You will likely have to pay for almost all of that root canal and crown out of your own pocket because your insurance has been exhausted on your other visits earlier in the year. But wait! Your insurance may not even cover the procedure because it may not be seen as “medically necessary.” There is a chance your insurance, which you pay for monthly, will pay for none of this required treatment.
I am tired of seeing dental insurance companies take our patients’ insurance premiums every month and then deny them access to these funds when they are needed. There are too many clauses on insurance policies. If there isn’t a clause to cover a procedure they don’t want to cover, then there is a waiting period or a flat out “we don’t cover that.”
My front office team, my hygienists, my assistants and I have personally spent several hours each week writing letters to the insurance companies on the patient’s behalf. We are an honest, ethical dental practice that stands behind what treatment plans we offer to patients. But as time goes on, the frustrations mount when patients are consistently being denied their own benefits. The patient receives letters from the insurance company saying, “These procedures aren’t necessary.” How would they know? Did they meet you? Did they examine your condition in person? No. Why are they trying to determine how you can use your benefits?
We introduced the HPD Membership several years ago and only a few people took us up on this offer. But as time goes on, more and more people are actually jumping off the dental insurance boat and onto the HPD membership plan. We have no insurance claims, no denials, and no waiting periods. With your membership, you get Zoom In Office whitening or a Sonicare toothbrush included. You get a discount on our treatment schedule. Your healthy mouth cleanings are covered.
I wish we could get all of our patients on this membership plan as it saves patients money, time and energy. It saves patients the stress of dealing with insurance companies that likely don’t care about your finances or health, unless it benefits them. In my opinion, the dental insurance companies are similar to the cable TV business. They are outdated, don’t help you when you need it and aren’t about the customer. Highland Park Dental is a “thinking outside of the box” dental office. This is just one manner in which we separate ourselves from the others. We are looking after you, for you, with this HPD Membership plan.
Thank you for reading. I hope you found this piece someone enlightening or educational. I could type until my fingers fall off about how I feel about this subject matter, but yet, I have more insurance claims to fight, appeal and try to win so the patient can use their benefits they have already paid for with premiums.
Aaron B. Jones, DDS
Highland Park Dental
Highland Park Dental
6725 Hillcrest Avenue
(next to Starbucks in Snider Plaza)
Dallas, Texas 75205