What You Need to Know About Dental Insurance

We started Soothing Dental to make the experience of “going to the dentist” a great experience. Having said that, there are many areas in the dental world that need improvement. One of these areas, and a complicated one, is the dental insurance. Even though dental insurance is a financial product, it’s directly related to the quality of the service that one receives.

Here is some basic information about dental insurance in general that can help you decide what insurance plan to get and how different types of plans will affect your oral health.

Dental insurance services are traditionally provided by financial companies that are not offering any actual dental service. They sell “dental plans” to small groups (e.g. companies) or individuals. These financial products are first and foremost services that are supposed to make money for insurance companies. That means that the money that insurance companies receive from its clients is more than the money that they pay to dentists for their services. The issue is their margin is usually high and as a result they are one of the biggest overhead costs in the dental business. 

Having said that, it’s necessary to have an insurance plan to reduce the risk of having to pay high premiums for some procedures should the patient need them. It’s important to know the types of dental insurance services that are available in United States and choose wisely when selecting one for you and your family.

You may have heard about medical HMO plans. DHMO is basically a similar concept in the dental world. Here is how it usually works: You or your company or a combination of both pay a monthly fee. You will then select a dental office (and a specific dentist in that office) as your primary-care provider. You can only go to this one office and see this one dentist in most cases but most of your expenses will be covered. Here are some catches:

• There is usually a cap on the frequency of doing various procedures. For example, some plans may not allow you to do more than 1 crown per year.
• The insurance companies usually pay a low percentage of the money that they get from the patients (or their companies) to dentists. That’s why in most cases dentists who work with DHMO plans cannot afford to offer high quality services.
• Most DHMO plans only cover basic treatments and in many cases out-dated treatments. For example most DHMO plans cover amalgam fillings and not the composite/white fillings. Most patients prefer to have composite fillings since amalgam fillings are aesthetically unappealing. If you have a DHMO plan and would like to do a composite filling, you are likely to pay the whole amount yourself (as if you don’t have any insurance).

Dental PPO (preferred provider organization) plans are similar to medical PPO plans. You and/or your company pay a monthly fee to an insurance company and in return you can go to any dentist and the insurance company will cover your expenses completely or partially depending on many factors. The PPO plans are more flexible than DHMO plans but they have their own restrictions:

• Like DHMO plans you are limited to a cap on the frequency of doing certain procedures. You are also limited to a certain annual budget for your expenses. This means that you may have to postpone your treatments to next year if you exceed your annual budget.
• Not all dentists are the same when it comes to PPO plans. Depending on your plan a dentist may be considered in-network or out-of-network for your plan. Insurance companies pay different fees and cover a different percentage of your expenses for in-network/out-of-network providers.
• Most procedures are not covered at 100%. That means that you are likely to pay out-of-pocket for a portion of your expenses when you see a dentist. The coverage ranges from 30% (for some plans and some procedures) to 100%. The average is probably 50% for an average plan. If you want more coverage, you’ll have to pay higher monthly rates.

Dental insurance plans (both PPO and DHMO) are usually not covering elective and cosmetic procedures like whitening or nitrous gas.

The cost of a plan depends on the following factors:

• Coverage: What percentage the expenses is covered by the plan. Also, what procedures it covers and if there are any frequency limitations.
• Participating dentists: Are there any high quality dental offices that accept the plan? More often than not, DHMO plans are not accepted by premium dental offices. Dental offices are also selective on what PPO plans they accept.
• Group size: Generally speaking a plan becomes more affordable if you have more people in your group. For example if you have a small business and get the plan for everyone in your company (regardless of if the business itself is contributing to it or not), you will get much better rates for the same coverage than if you get individual plans. Some plans are not even available to small groups or individuals.

At Soothing dental we work with different insurance companies. We are also announcing the launch of our own dental insurance plans in Bay Area to make concierge dentistry accessible to everyone. Our plans start at $20 per month and cover many services at 100%. We also cover whitening, nitrous gas and other procedures that are not covered by other insurance plans. Our plans are available to individuals and small companies. There is no waiting period and you can signup here now.