But My Insurance Pays For X-Rays.

Last week I called a patient who had a little past due balance on her account. Mrs. Goodson has always paid her bill on time. I asked her “why the delay?” She replied,” I only came in for a cleaning and my insurance should have paid, you need to contact them.” I explained to her that I had contacted her insurance and that they told me that they only cover her Bite-wing x-rays once every 2 years.

Mrs. Goodson was extremely surprised. She has the same Delta plan for over 15 years, and they always paid for bite-wings once per year. I took a moment and reviewed her account history, she was right, but her policy had changed. Her Delta Dental plan changed the frequency for x-rays. Her policy states that they only pay for bite-wing x-rays, once every 24 months; for age 18 and older and once per 12 months for age 17 and younger.

They must believe that when people become 18 that magically they will stop having any decay! I am betting that someone had an idea on how to lower their overhead. I wonder what they will take away next?

With your success in mind, 

nomi8Nomi

3 Comments

  1. TheDentalWarrior | | Reply

    Shouldn’t be any surprise. First, I explain that it’s NOT insurance. Dental plans are, by definition, NOT insurance. Insurance is an entirely different financial instrument. Just because they call it “insurance,” doesn’t make it so. It’s a dental BENEFIT plan. Dental plans pay a defined (and always very limited) benefit. When dental plans were invented in the mid-60s, they offered a $1000 annual maximum benefit. Here we are 50 years later, and it’s STILL $1000.

    $1000 in 1965 is the equivalent of $7,094 in 2011. So, that $1000 in 1965 is now worth about $150. And, that’s why we call dental plans, “Tooth of the Year Club.” Today, your plan will fix ONE tooth. In 1965, you could get a lot of dentistry for $1000.

    Insurance companies do not exist for the benevolent health care of their policy holders. They exist to make a profit. Period. They are a disinterested 3rd party dipping their hand in the pot. They are certainly not the arbiters of what constitutes good health care. But, somehow consumers have fallen for that false belief.

    Thankfully only 8% of my patients have a benefit plan. 92% are self-pay. When a patient asks me, “Which insurance should I get?” I tell them none. It’s a bad wager if you do the math. If you calculate the premiums vs. the measly “benefits,” it’s simply a bad deal. You’re better off putting $50 a month into a savings account and paying for your dental care out-of-pocket. That is provable with MATH. But, people don’t like doing math. It’s tough to fight emotion with logic, math, or science. People want to believe what they want to believe.

  2. Lesley | | Reply

    I just dealt with the same thing in my office! These insurance companies drive me crazy with the things they change and take away from patients.

  3. Missy | | Reply

    I hate having these kinds of conversations with patients…which is EXACTLY why we research EVERY patient’s dental coverage before they come in. We ask about frequencies for just about everything so we can tell the patient ahead of time. It makes my life easier!!

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