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Dental Insurance Questions

This Web page answers commonly asked questions about dental insurance.  First the question is stated followed by my answer.  I hope this helps... Dr. Wilson    (P.S.  If I don't answer your question, please E-mail me (below  at the end of the page) and I will add your question to the list!)

"What insurance plans does your office accept?" 

We accept all insurance plans that allow you to choose your own dentist.  

"My insurance plan has a list of dentists that I have to choose from.  Are you on their list?"

Probably not.  The only "list" that I am on is with Delta Dental Insurance.  I am a "Delta Dentist".

Some 'List' type of dental plans will allow you to go to the dentist of your choice but they often 'penalize' you by paying out lower insurance benefits for the 'non-list' dentist.

"Dr. Wilson, why haven't you joined these "List" type of Dental Insurance Plans?

To answer this question, I must first educate you a little bit about Dental Insurance.  'List' Dental Insurance plans are called PPO's or HMO's.  

PPO stands for Preferred Provider Organization.   A PPO is a group of dentists (the 'list') and a dental insurance company.    The group of dentists have agreed to accept the insurance company's fee schedule (price list) instead of the dentists' normal fee schedule.    Generally the insurance company's fee schedule is about 30% below 'the usual and customary fees' of dentists in the area.

An HMO is a Health Maintenance Organization (sometimes also called a Dental Maintenance Organization or DMO).  An HMO is a group of dentists (the 'list') and a dental insurance company.  The group of dentists have agreed to treat a particular group of people (usually a large company) for a fixed amount per month per person (whether they come for treatment or not).  My experience with this type of plan is that the dentist finds that the payment reduction he receives is even greater than the PPO 30% reduction!

The "overhead" in a dental office is all the costs of maintaining a dental office before the dentist receives any compensation.   The overhead in my office averages about 70% (about average for most dental offices).   Now you don't have to be a "rocket scientist" to see that there is a problem here.  If I accepted these types of plans, I would be treating you without receiving any salary at all!  Unless, of course, I changed the way I treated my patients...

"Dr. Wilson, how is it that other dentists are able to accept these plans?"

I hope you understand that I can not slander other offices on the Internet!  I can legally only tell you what I would have to do if I accepted these kinds of plans.  The following is a list of the things I would have to do to accept these plans.   This list is precisely the reason why I refuse to take these plans.

1. I would have to compromise the comfort of my dental work.  People who have a sensitive mouth take extra time.   Giving extra numbing or  Nitrous Oxide ("laughing gas") take extra time.

2. I would find myself compromising the cosmetic quality of dental work I performed.  It takes extra time to get the shade right or to make things look natural.  Haste makes for an "assembly line" unnatural look. 

3. I would compromise the quality of my dental treatment.  I would have to schedule less time for procedures and rush my work and jeopardize the quality of my work.  Poor quality dental work may not be noticeable at first but months or years later the problems start to happen.  Crowns and bridges fall out.  Teeth start to hurt.  Gums become infected.  Not a pretty picture!

4. I would have to use a cheap dental lab.  Crowns, bridges, and removable appliances are almost always made by a dental laboratory.  Would you send your car to the cheapest mechanic in town?

5. I would have to fire my staff and hire lower wage people to cut salary costs.  Right now I have well trained, experienced staff to sterilize instruments, work in your mouth, answer insurance problems, etc.   Would you want untrained, inexperienced people doing these things for your family?

6. My patients would have to wait and wait and wait even though they had an appointment.  I would have to "double book" my appointment book and schedule less time for procedures in order to make a profit.   If everyone shows up for their appointment or a procedure takes longer than expected, there is no 'cushion' and you, the patient, must wait and wait.

7. And the list goes on and on.   The truth is that the average dentist does not have allot of "fat" to cut so that the savings can be passed on to the consumer.  Dentistry is a 'custom-made' service where the old sayings "haste makes waste" and "you get what you pay for" are as true as ever!

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Last modified: August 16, 2000
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