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Question: “Dr. Arnold, it seems like my dental
insurance covers less and less every time I visit my dentist. Why
is that?”
Answer: Dental insurance was originally introduced
in the late 1960’s. At that time, the average
total annual benefit was about $1000. That allowed
patients to have insurance pay for a lot of dental care
each year. More than thirty years later, this maximum
annual benefit hasn’t changed for many plans. Allowing
for growth at the average rate of inflation, this annual
benefit would have grown to about $7000 by 2006.
Unfortunately, while the annual benefit has not changed
much over this period, dental expenses have increased substantially. This
means that the average dental patient has to pay more money “out
of pocket” each year for dental services. It
is probably more accurate to refer to dental “insurance” as
a “dental benefit plan.” While it is nice
to have, it generally doesn’t provide the same benefit
that it once did.
There are many different types of dental insurance plans,
but the most common are: traditional (or “indemnity”)
plans and managed care plans. Additionally, many
employers are cutting out the “middle man” to
provide greater benefits to their employees and savings
to the company using Direct Reimbursement plans.
Traditional (indemnity) dental plans provide payment for
services on a “fee-for-service” basis. Some
procedures may be covered completely, while other procedures
will be covered at different percentages. The level
of coverage is usually determined in part by the amount
paid in premiums by the patient’s employer. The
patient is responsible for whatever portion is not covered
by their plan.
With traditional plans, patients may choose any dentist
they want to perform their dental care and receive the same
benefit. Managed care plans usually limit the benefit
received if the patient selects an “out-of-network” provider.
Within the realm of managed care, the most common plans
are DMO’s (capitation plans) and PPO’s. In
my next column, I will discuss managed care and direct reimbursement
plans in a little more detail.
Dr. Arnold practices dentistry in Chesterton and Valparaiso
and is a clinical instructor with the Hornbrook Group, which
teaches contemporary dental techniques to dentists from
around the country. For more information on this
or any other dental topic, please visit: www.smilesbyarnold.com. If
you have questions for Dr. Arnold, please send an e-mail
to: drarnold@smilesbyarnold.com or
a letter to: 1830 South 11th St., Chesterton, IN,
46304
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