That’s right, a scam! Have you ever looked at your dental insurance closely to see what they pay for, how much they will pay and what you pay for? In the last year I had thousands of dollars of dental work done, so I am a bit of an expert. Clearly, not all dental insurance plans are the same, so you would have to take a close look at your plan to see how it relates.

There are different kinds of dental insurance plans. There are Dental Health Maintenance Organizations or DMOs and there are PPOs or Preferred Provider organizations. In either type of plan, you normally have to select a primary care dentist, who would then refer you to specialists as required. The DMO dental insurance requires you to go to a plan dentist for all treatment unless it is an emergency and you can’t get to your primary care dentist. The PPO dental insurance gives you a better discount and pays more if you use dentists who are PPO providers. Many dentists don’t like being part of a DMO because they have no control of the rates they charge to DMO patients. In a PPO, dentists charge what they want, the insurance pays what they want, and the patient pays the difference. Many procedures have to be approved by the insurance company first. A DMO will probably have a higher yearly and lifetime limit on what they will pay than a PPO. PPOs typically will only pay $1200 to $1500 per year and probably have a lifetime cap on spending.

There are two other options for paying for dental work in addition to insurance. They are paying full price and discount plans, where you pay cash for the dentistry, but the dentist has agreed to charge less to plan members. Obviously if you pay full price, you can go to any dentist you want. If you have a discount plan, you have to go to a dentist who has agreed to charge a lower price.

So here is how the PPO works:

I pay annually: $578.76
Deductible: $50.00
Annual Maximum benefit: $1500.00

So right up front, I am paying $628.76 to get $1500.00. This is not a great deal, but I get an extra 870 dollars or so, right? Well maybe. Lets continue with this analysis. If I only get the minimum done, say appointments with cleanings, xrays. I still haven’t spent anything except the monthly fee, but how much would I have spent? In my area an exam costs about $70.00, so if I do two of them, that will be $140.00. The cleaning would cost about $115.00, so I did two of those, totaling $230.00. I think the xrays cost about $30, so a total of $60 for the year for them. So here is the summary:

So if I don’t do anything except get the free stuff, I get to pay $578.00 for $370 dollars worth of stuff! What a great deal! But, you say, you have the protection just in case you have to have more stuff done. OK, lets look at that.

Lets say I have to get 3 cavities filled, two single and one double surface, a bicuspid root canal, and a crown. My plan covers 90% if I go to a plan provider. In addition to all the “free” stuff I get:

Since they only will pay $1500.00 in a year, they will pay only $1500.00 of this, leaving a total of 1472.00 for me to pay. The 10% and the $50.00 deductible are irrelevant here, so for the year, I will pay a total of $2040.76 for $3342.00 of dental service. This isn’t such a great deal, and the ratio of cost to savings gets worse the more you have done.

So what are the alternatives? I would rather pay to get some discount than none. You could pay full price, of course, or you can get discount plans. In my discount plan, I have no maximum, and no deductible. I pay everything, and we (the dentist and I) don’t have to ask the insurance company for permission to do a procedure. Here is what the same services look like with a discount plan.

I have saved almost $500.00 over what I would pay with insurance, I still have protection against serious problems, and I have eliminated the hassle of insurance companies! The total for the dental work is less than half of the regular price! The more work you have done, the more you save! Now the other thing about this discount plan is that it covers your entire household, up to 20 people, AT NO ADDITIONAL COST. In the PPO, I have to pay more to add more people. They all have a $50.00 deductible, and they all have a $1500 maximum. There is no additional cost for any other person on the discount plan, so for the same set of procedures you just pay for the procedure, or $1307, increasing your savings over the insurance plan even more!

I know what you are saying! If I only do the basics I still have to pay the $240.00 annually for just the exam and cleaning. OK, but instead of paying $578.00 for 370.00 worth of procedures, you are now paying only 362.00 for the same services. A savings of $216.00. It even saves over paying full price! I don’t know about you, but if I can get the identical procedures done for less, that is a better deal! Either way, you save!

Help reduce healthcare costs! Join a discount Dental Plan and dump your insurance scam!

Ted Wilcox
(619) 399-7559
www.tmwilcox.com/benefits