dental insurance principles

[roger]

Hi, all. I was just reviewing my benefits and thought of some questions that I hadn't thought of before about the way dental insurance works. If anyone works in this line or has any insight, please jump in.

- Was dental always separate from health? I guess you could say the same about vision. Why?

- Is the goal of dental just supposed to be about sharing the cost with the insurance company, which has the strength to negotiate price with providers? While the worst dental problems won't cost anything approaching that of bypass surgery, and while we need our hearts more than we need teeth, the costs of unanticipated dental work can be rather prohibitive for a working- or middle-class family. It seems that the typical employer-sponsored plan only covers half of the most expensive procedures, subject to limits that probably haven't increased in at least a decade.

- I can understand the incentives involved in covering most or all the basic and preventative work, but as in anything else involving the body, there are some things that are influenced by the genetic hand we're dealt and age, so I can see the need for more risk-spreading, too.


If anyone has some information on why the benefits in this line are typically structured the way I think they are, I'd be interesting in learning.

[Dr T Non-Fan]

Originally Posted by roger

Hi, all. I was just reviewing my benefits and thought of some questions that I hadn't thought of before about the way dental insurance works. If anyone works in this line or has any insight, please jump in.

- Was dental always separate from health? I guess you could say the same about vision. Why?

- Is the goal of dental just supposed to be about sharing the cost with the insurance company, which has the strength to negotiate price with providers? While the worst dental problems won't cost anything approaching that of bypass surgery, and while we need our hearts more than we need teeth, the costs of unanticipated dental work can be rather prohibitive for a working- or middle-class family. It seems that the typical employer-sponsored plan only covers half of the most expensive procedures, subject to limits that probably haven't increased in at least a decade.

- I can understand the incentives involved in covering most or all the basic and preventative work, but as in anything else involving the body, there are some things that are influenced by the genetic hand we're dealt and age, so I can see the need for more risk-spreading, too.


If anyone has some information on why the benefits in this line are typically structured the way I think they are, I'd be interesting in learning.

-#1: No idea about the history of separateness, but different providers and a completely separate list of services make having different products the easiest solution.
-#2: Goal of dental insurance is to provide a product that employer groups want, else lose the medical insurance business.
-#3: It's more cost-spreading that risk-spreading. Dental is interesting in that it is one area where preventive action definitely affects long-term high costs. Downside is that prevention has to start at a very young age, since fillings last only about 35-40 years, after which crowns normally have to replace them. (Dentists are cleaning up on Boomers right now.)

Information: high-cost dental procedures are often the result of low maintenance. "Constant vigiliance!" is required.

[Angstrom]

#1: Why not medical?
(a) Medical might get moved every year or two due to high cost increases. It is pain to move the other group lines (dental, vision, LTD, STD, Life). It is a easy for the broker/consultant to leave these in place, shop separately or less frequently.

(b) Dental has always had a preventive focus that didn't fit well into most traditional medical cost sharing formulas.

(c) Dental is relatively new vs. Medical. Early players had it separate.

#2: With no catastrophic claims, why does it exist?
(a) Pre-Tax dollars reduces costs. Negotiated discounts basically offset admin/commission fees. Few people cost shop or quality check dentists. Networks do that for the insureds.

(b) Prestige factor for employers ("We offer dental!"). Prestige factor for employees ("Mom, my new job has dental!").

(c) People are way more likely to go to the dentist if they have coverage. Good for wellness.

(d) People buy it. It boggles my mind, but from some studies I've seen, people will pick dental before STD/LTD. Dental seems more tangible to people since you generally see annual benefits. Insurance is still abstract to most people.

[FormLetter]

I think the prestige associated with having dental coverage is a good thing, as it convinces people to covet it, and hence use it. In order for the expensive procedures to be covered, the individual has to go get all their preventive visits done. I think lots and lots of people wouldn't go to the dentist until they had a problem otherwise.

[3rookie]

Originally Posted by Angstrom

Few people cost shop or quality check dentists. Networks do that for the insureds.

Good post, other than this comment. The only quality check that networks do is check with the state to make sure the dentist is licensed and doesn't have a bunch of negative findings on his/her record.

My strong opinion is that in-network dentists are of lower quality than out-of-network dentists. The lower price of a procedure results in a lower cost lab and materials, as well as higher volume (less individual attention).

Of course, the comparison of two dentists is near impossible to the average person. Most people equally don't like any of them.

[FormLetter]

I've had both good and bad dentists in my time. The last bad one makes you feel like it is a mill. He is in there for about 3 minutes tops.

[Dr T Non-Fan]

"So long, Dental plan!"
"Lisa needs braces."
"So long, Dental plan!"
"Lisa needs braces."
"So long, Dental plan!"
"Lisa needs braces."
"So long, Dental plan!"
"Lisa needs braces."
"So long, Dental plan!"
"Lisa needs braces."
"So long, Dental plan!"
"Lisa needs braces."
"So long, Dental plan!"
"Lisa needs braces."

[Angstrom]

Originally Posted by 3rookie

Good post, other than this comment. The only quality check that networks do is check with the state to make sure the dentist is licensed and doesn't have a bunch of negative findings on his/her record.

My strong opinion is that in-network dentists are of lower quality than out-of-network dentists. The lower price of a procedure results in a lower cost lab and materials, as well as higher volume (less individual attention).

Not my experience. I've worked for a company that does way more than the license check. They take this pretty seriously.

I've seen lots of really good dentists on the panel that aren't a dental mill. Typically older dentists that aren't carrying any debt (school debt, debt to fund start-up costs, debts to buy into a practice). They can still fund a really good lifestyle even on the network prices.

Are there high volume practices that can still be high quality & have good outcomes? Sure, in fact most do. Overall, I don't have much problem with high volume dental practices. You just need to understand this is the equivalent of going to Applebees, not a steakhouse.

Originally Posted by 3rookie

Of course, the comparison of two dentists is near impossible to the average person. Most people equally don't like any of them.

I love my dentist. I know about 8 people who go to my dentist and they all love him. He is low volume & knows everyone personally. I do pay for that privilege.