Understanding Dental Insurance (Podcast)

John Maher: Hi, I am John Maher. I’m here today with Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, helping patients recognize the vital connection between dental health and whole body health. And author of the bestselling books “Age with Style: Guide to a Youthful Smile” and “Healthy Living and Total Wellness: Understanding the Link Between Your Teeth and Your Health”. Today, our topic is Understanding Dental Insurance. Welcome, Dr. Nammy.

Dr. Nammy Patel: Hi, John. Thank you for having me.

What Does Dental Insurance Cover?

John: Sure. So Dr. Nammy, how does dental insurance work and what types of coverage are typically included in dental insurance plans?

Dr. Nammy Patel: Dental insurance is really interesting because I don’t know why your mouth is not covered under your medical insurance. And things are really straightforward between medical insurance and dental insurance because they’re very, very complicated believe it or not.

So dental insurance is interesting because they only cover a certain amount per year. For example, you have a plan that’s going to cover $1000. If it’s medical insurance or you’re going to have a deductible, and then they will pay the rest. For example, then you pay up to $1000 and then they’ll cover everything else. With dental insurance, the maximum they’ll pay is going to be $1000.

And on top of that, dental insurance will only cover certain procedures at a certain percentage. So for example, if you needed a crown it would only cover maybe 40 to 50% of that crown. And the type of crown that they’ll cover is going to be a base metal crown, not a biocompatible ceramic crown. So that 50% is really like 25%. So it’s really limited.

I like to call dental insurance a coupon. We’re definitely going to help you utilize it, but it’s a coupon that’s going to give you some sort of a discount, but not really. I wouldn’t rely on dental insurances to cover everything because they won’t. They’re helpful, sure, if you have it, it’s definitely helpful, but it’s not something that I would solely rely on.

Misconceptions About Dental Insurance

John: Are there any other common misconceptions about dental insurance and how can patients avoid surprises and unexpected costs when they’re seeking dental care?

Dr. Nammy: The common misconception is that, there are actually more common misconceptions about a dental office or a dentist. Patients are always saying, “Oh, the dentist is trying to scam me,” or “You charged me all this. Why didn’t my dental insurance pay for this?” Because your dental insurance isn’t designed to pay for it. They have so many stipulations.

If you look at your plan, you will see… We have, in my base of 5,500 patients, we have like, gosh, we must have at least 10 to 20,000 different plans. And out of those plans they’re also unique in each stipulation. One of them will cover, you have to wait six months before they cover a crown or even a deep cleaning. Some of them will cover everything right away. Or some of them, it doesn’t matter what you need, they’ll go ahead and cover it up to $500.

And so there’s just so many different plans and different ways that they cover things. So the misconception that dentists are taking advantage of their patients is absolutely false. And the first thing I’ll say is notate that. And then the second is we’re very transparent about our cause. Anytime we do a treatment plan we give you the actual amount without insurance first. So you should always look at that number, not what am I paying after insurance.

It’s like when you go to a restaurant, you always order and then you’re always surprised at the bill because there’s, like in California there is the San Francisco employee tax and there is the San Francisco Health Mandate and then there’s a California taxes that go on top. So your bill ends up being a lot higher. So when you’re looking at dental insurance we actually say, “Look at the bottom, the full bottom line first, and then we’ll break it down for you as saying this is what your insurance is going to cover.

This is your portion. If your insurance doesn’t pay, you’re still responsible.” And that’s the key that you always want to note is that you’re responsible no matter what.

How to Maximize Your Dental Insurance

John: Okay. How can patients help to maximize their dental insurance benefits and ensure they’re getting the most out of their coverage?

Dr. Nammy Patel: The best thing to do with that is definitely go in for preventative care and regular checkups and then also be open with the front desk to say, “Hey girl, hey ladies,” or “Hey receptionist, how can you help me maximize my plan? If there’s something I need, I want to do it.”

The one thing I would caution you against is there are a lot of things your dental insurance will cover that you don’t need. For example, they’ll cover x-rays every six months. You don’t necessarily need them. So I’d just be really cautious on what you actually do. So always look at what you need first and then see how your insurance can help maximize that.

Should People Get Dental Insurance?

John: Okay. And what advice would you give to someone who’s considering purchasing dental insurance who may be dissatisfied with their current coverage or their provider?

Dr. Nammy Patel: To be honest, I actually recommend that you don’t get a plan. Many offices, we actually have our in-office insurance plan, which is usually about 10 to 15% off, which is going to give you a better benefit and it’s a straighter, easier way to see what your benefits are going to be. And it’s much better for you because what happens with dental insurance is that you pay and then, you pay the dental company. They’re only going to cover a little bit and then you’re going to have to pay our practice as well.

So it may, number one, it muddies the relationship up between the dentist and the patient. Number two, it’s really confusing. And it’s better to keep it clean and it’s not even worth it financially. If you do the math at the end of the day, if you look at how much dental insurance is costing you… For example, I have a lot of patients who pay $600 per year, about $50 a month for their dental insurance. And if we look at the year amount on how much they actually spend it’s less than that.

So I would just say, just do your homework. Look at what are you spending. You can always ask a dentist, what am I expecting to pay? What am I looking at? And that way you can find something that’s more customized for you.

John: Right. And like you said, knowing that you have the insurance and the insurance covers certain things you might end up getting some things done like X-rays that you don’t even really need or want as often as the insurance will cover it, and then things like that. So it almost forces you down a plan where you’re saying, “No, I’m not going to do that because it’s not covered by the insurance.” Or, “Yes, I will do this because it is covered by the insurance.” And those things might not be the best things to do for your health.

Contact Green Dentistry to Make an Appointment Today

Dr. Nammy: Yes, absolutely.

John: All right. Well that’s really great information, Dr. Nammy. Thanks again for speaking with me today.

Dr. Nammy: My pleasure, John.

John: And for more information about Green Dentistry, visit the website@sfgreendentist.com or call 415-433-0119.