Straight talk about dental insurance, from the owner — what your plan actually covers, and why we've chosen to stay out of network with nearly every insurance company.
Many people across the US compare the costs of buying dental insurance for their family’s dental needs against simply paying out of pocket. Here’s a brief summary of how most plans work — their advantages, and their negatives.
Most family dental insurance plans excel at preventative and basic services. Insurance companies categorize normal prophies (cleanings), fluoride treatments, sealants, X-rays, and exams as basic treatments, and cover these usually 100%.
In or out of network, 98% of the time you’re going to be covered 100 percent on these basic items.
Basic services usually include fillings, extractions, and deep cleanings, which under a standard 100/80/50 plan are covered at 80 percent — again, in or out of network, usually 80% after deductible.
More expensive services — crowns, bridges, implants, dentures, partial dentures — are covered at 50% after deductible.
Most plans pay the usual 100/80/50% breakdown whether you opt for an in-network or out-of-network dentist. Some plans (sadly most of the Humana and United Concordia plans, and probably half of the United Healthcare plans) unilaterally decide that they don’t care what a dentist charges — they will only pay on a super-low fee schedule that barely covers staff and supply costs. The worst offenders tend to deny even the most basic services as unnecessary; simple diagnostic periapical X-rays get denied unless the dentist hand-writes a reasoning narrative for a seven-dollar X-ray. The goal is to require so much paperwork that most dentists simply give up and charge the patient.
Here is the truth: most insurance companies have the largest buildings in town. Look at some of the most beautiful buildings on the George Bush Turnpike in DFW and you’ll notice large insurance company names on them. That’s because they tend to pay out a lot less than they take in via premiums. I (the owner) looked into last year’s statement by Delta Dental: they averaged $470 per insured in yearly premiums, and averaged $240 per insured paid out to dentists. They’re keeping nearly 50 cents on the dollar. And you wonder why the Giants play in “MetLife Stadium,” at a cost of $400 million over 20 years. Those are your premium dollars at work.
To save money, insurance companies tempt family dentists into signing up as in-network providers, promising to direct patients to their offices in exchange. This is where things get sticky: the in-network dentist has to accept around a 50 percent reduction in pay for in-network patients.
So how does that add up? What happens is that every deep filling gets converted from a $90 in-network two-surface filling into an $1,850 root canal, build-up, and crown. The doctor makes almost no money after costs on the $90 filling, but definitely makes money on the $1,850 root canal and crown. Forcing a doctor to choose between losing money on a filling and making money on an “upgraded” treatment is tempting him to be unethical. Likewise, a dentist might choose to make a resin flipper with a wire clasp instead of a cast-metal-framework partial denture (a far superior product), merely because the lab fee on the flipper is $150 versus $400 for the good one.
Insurance companies are, in effect, training dentists to recommend the cheaper and inferior product. All they care about is how tall a skyscraper they can build — not how well your teeth feel, look, and function.
We at North Garland Dental & Orthodontics have resisted this by staying out of network with nearly every insurance company. The ones we have contracted with pursued us, offering 95% of our normal fees to sign up. Insurance reps wait in our waiting room to negotiate with us — basically unheard of in DFW, where the average discount is 40–50% off usual and customary fees.
Our out-of-network insurance companies send us no patients. We rely on word of mouth and stellar Google reviews for new patients. We charge enough for our fillings that our doctors can honestly give you our recommendations, without worrying about losing money when they choose the ethical option.
Our goal is your improved oral health — and we will never allow an insurance company’s fee schedule to dictate treatment.
No insurance, or a plan that doesn’t pull its weight? Our in-house Dental Savings Plan covers your yearly essentials for one flat fee, and financing through Cherry breaks bigger treatment into monthly payments.
Bring your plan details to your visit — or call and we'll talk through what your insurance actually covers before you book.