Dental Insurance: Facts and Reality Checks


Many dental practices fall into the trap of letting dental insurances dictate the care and well-being of their patients.  

Reality Check#1:  The people who review insurance claims and treatment plans are clerks with no dental training.  They have never seen or examined you.  They don't know your medical or dental history.
Yet too many patients let these unknowledgeable people dictate their health care decisions.

The Dental Leaders practice is built on the premise of being responsible to you, and only you.

The traditional doctor/patient relationship is alive and well in the Dental Leaders practice!
We take the time to treat you in a caring, professionally conscientious, and educational manner. Regardless of any third parties.  And that is to your benefit, dentally and financially!
We treat you; we revere that relationship; and help you to achieve the dental health goals that you agree to.  THAT is a contract between us!
Remember, insurance companies are in the business of keeping your premium money.  That is how they make profit.  They take in more money than they pay out.

What We Do:

  • Through service, attention, timeliness, quality, preparation, and training; to be continuously worth the choice to go out of network!
  • As a service, we make reasonable attempts to confirm that you are covered and a get a basic description of your benefits
  • As a service, we file insurance claims and predeterminations on your behalf
  • As a service, we follow up two times on unpaid claims, including answering their questions and supplying requested information
  • As a service, we inform you when/if those reasonable attempts have failed so that you can take up the issue with HR or on your own behalf
  • As a service, we do participate in the best PPO programs in the area.  Presently these are Aetna, Cigna, Delta, Assurant, Met Life, and Guardian
  • As an obligation, we treat your dental health in the most appropriate, durable, and comfortable manner possible

What We Don't Do:

  • Make compromises or do the wrong thing because of any insurance pressures
  • Carry balances for more than 90 days, regardless of insurance benefits, without a pre-treatment agreement
  • Take any responsibility for the positive or negative actions of your dental insurance.  That contract is between you and them
  • Guarantee any payment or action from dental insurers.  We have no contractual power to make them do anything.  You, or your employer, have that power

your responsibility:

  • Personally understand the costs of your proposed treatment and have your financial questions answered in a satisfactory manner prior to proceeding with treatment
  • Become an educated consumer of dental health care.  Ask a lot of questions.  Take personal responsibility for your dental health.  Don't assume anything.
  • Become an educated consumer of dental insurance.  Understand their motivations.  Understand that they are not doctors 
  • Don't expect that your dental insurance provider is your ally in your dental health nor do they have any health care responsibility to you in any way
  • Accept responsibility for your dental insurance contract and benefits
  • Accept responsibility for your balance regardless of insurance payments
  • Provide timely and accurate insurance information
  • Understand that your dental insurance might not pay for the best possible treatment for you
  • Request a predetermination of benefits if the insurance payment is critical to your finances
  • Understand that insurers sometimes do not pay even when there is a predetermination of benefits
  • Pay your balance after 90 days, regardless of any issues with dental insurance

History of dental insurance

Interestingly, dental insurance became an entity while Richard Nixon was president of our country.  It was a time of change, increasing social consciousness, and movement from a production to a service economy. Many more white collar jobs were created, people's health awareness was increasing, and demand for job benefits was rising.  Dental insurance in the 1960's paid a maximum benefit of….$1000 to $1500.  At that time, that amount would pay for three to five dental crowns per year!  Very few claims were denied, and dental insurance became a traditional employment benefit for white collar workers.  Insurance companies only offered dental so as to get the much-more-lucrative medical insurance business from employers.

Fast forward fifty years to 2014.  The maximum benefit paid today is…..$1000 to $1500!  That number has never changed in the face of inflation and the general rise in the costs of delivering health care.  That amount now may cover one crown per year.  In addition to this lack of movement , the contractual policies of the insurance industry has become increasingly limited and hostile to doctors.  Much more documentation is requested from the dentist and the patient, to the point that most offices have had to add one or more FTEs (full time employees) just to handle the increasing paper or electronic workload required to receive increasingly less benefit on behalf of the patient.  Yet, this is our world today.

Reality Check#2:  Dental insurance is no longer insurance.  It is assistance, and only exists because it has become a traditional benefit.  And in this world of financial bottom lines and quarterly reports, the insurers no longer see dental insurance as a loss leader to get the medical business.  They appear to be squeezing every dime out of their insured patients.  And they twist circumstances and language to appear to place the onus of responsibility on the dentists.


Your dental insurance is almost always a contract between your employer and the insurance company, or you personally and the insurance company.  Many people believe that the dental office can "do something" about how the dental insurance pays.  Not true.  We have no influence over their behavior in any way.  We are not a part of that contractual agreement.  Many people also believe that the dental office is supposed to "know everything" about their dental insurance.  This is also not true, as each individual contract is different, and each claims department seems to have its own personality and "quirks".  

So who IS responsible for knowing everything about your dental insurance?  YOU, and your HR Department.  And it is not easy. 


There are three basic types of commercial dental insurances on the market:

  • Tradtional Indemnity- this type of insurance is rapidly receding from the marketplace.  This insurance allows total freedom of choice as to doctors, and minimal limitations as to procedures.  It pays a percentage of charges up to a maximum benefit each year.  Deductibles apply.
  • PPO- Preferred Provider Organization- offers "in-network" dentists who agree to provide treatment at reduced fees.  The patient is responsible for the difference between insurance reimbursement and the reduced fees.  PPO's also allow patients to go "out of network" and get reimbursed at a percentage of "usual customary and reasonable" fees, which the insurance company gets to choose!  The patient is responsible for the difference between that reimbursement and the fees charged.
  • DMO- Dental Maintenance Organizations- offer highly discounted dental services with low copayments.  Tend be offered in "clinic"-type offices with employed dentists rather than owner dentists.

Reality Check #3:  The Dental Leaders practice may not be for everyone.  Some people commoditize their health care to the point where they feel like all dentists are the same and provide exactly the same service.  These people see their dental insurance as the end-all and will only go to "list dentists" and only do what their insurance [untrained clerks] "allows' them to do.

Our patients seem to understand that there are visible differences in dental health care, and assume the fact that discount dentistry can only be provided by cutting corners somewhere.  We have a practice full of patients that do not want compromises in their oral health.  They want treatments that last.  They want quality materials.  They want accountability.  And they definitely do not want to be sold-to.  Our patients understand that dental insurance is actually merely an assistance, and take charge and responsibility for their own future health.  If this is you, Dental Leaders wants you as a patient.  Because we care about YOU.