Saturday, August 14, 2010

Dental Insurance... What is going on?

History of Dental Insurance
Did you know that dental insurance first came on the scene in the early 1960's. Did you also know that the typical annual maximum coverage for dental insurance was $1,000.00. The annual maximum has remained virtually the same for the past 50 years while dental costs have increased by a factor or about 700% since then. Interestingly, the rate if inflation or(CPI) for all consumer goods over this period is also $700%. So even though dental fees have matched inflation, coverage has not come close. I would also hazard a guess that the cost of the premiums have at least matched inflation.
What does it mean?
If the coverage was $1,000 per individual for a family of 4 in 1965, and the premium cost was about $10 dollars a month, and now premium cost is now say $7o.00 a month for the same $1000 per individual for the coverage for the same family of 4, where did the money go? Not to you the consumer, and not the dentist. It went to the Insurance company. Utilization has increased since your coverage does so little now. It now costs much more to process your claim even though we have electronic claims processing. Insurance companies also often employ a lot of delay tactics and loopholes to deny claims. In fact is seems that insurance companies spend more money and time trying to tie up, delay and deny claims than ever before.
We have to take unneeded x-rays and photos in order to document and justify more and more common treatment. More dental administrative time is being allocated to process claims and appeal denials. This drives up our costs.
Is Dental insurance important in your choice of Dentists?

One of the first questions new patients usually ask is if we accept their dental insurance. The question has been changing though more recently. Many patients have seen their traditional insurance plan changed to limited networks where they have to pick a dentist from a list, or risk paying a higher amount out of pocket.

History of Networks and HMOs
Back in the 1980's insurance companies tried to lower costs and called the plans HMOs (Health Maintenance Organizations) or DMOs (Dental Maintenance Organizations). HMOs turned out to be very unpopular due to the poor quality of care. These entities were very similar to the current "networks" being offered.
How is Healthcare Reform and the economy affecting Dental care?
Many Insurance companies have had to drastically increase their rates and find cost cutting measures as they gear up for "Healthcare Reform" These companies are being required to cover more people, with expensive "preexisting" conditions, and not deny coverage to anyone. This will drive up their operating costs. These costs must now be passed on. The recipients of this burden are:
  1. The patient with a plan that pays less.
  2. The employers who must pay more for the same coverage or opt for plans with poorer coverage.
  3. The Health care care provider, who is faced with a choice to join networks that pay very little of the actual cost of care or risk fewer patients with adequate means of insurance coverage to pay for the needed care.
Often the result here is emergency and patchwork dental care as patient can only afford limited care. The risk of a "network" is long delays, inadequate, sloppy care and mistakes, as high volume and low overhead is the key for them to remain profitable. In an economic downturn, the problems of this situation are magnified. Nobody knows for sure how this will play out.
What are we doing?
We at Crystal Lake Dental Associates are committed to high quality personalized dental care. We are also constantly trimming unnecessary costs in order to offer affordable care. We welcome your comments and questions.


Crystal Lake Dental Associates

280 B Memorial Court

Crystal Lake Il 60014

815 459 2202


  1. Dental insurance classifies dental procedures as preventative, basic, and major. Most dental insurance will cover at least preventative and basic procedures, but the amount of coverage will vary. from South Airdrie Smiles childrens dentistry.


About Me

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Born in the Midwest. Married with 6 children and 3 grandchildren. Attended Maine West High School, Harper Jr College, Northern Illinois University, the University of Illinois College of Dentistry. Practice in Crystal Lake, Illinois.