Dental insurance can be helpful, but patients should understand that it does not operate like traditional medical insurance. It is better viewed as a limited benefit intended to contribute toward dental expenses—not as complete coverage.
Dental benefit programs began developing during the 1950s and 1960s and became much more common in the 1970s. At that time, many plans provided an annual maximum benefit of approximately $1,000. More than 50 years later, many dental plans still provide annual maximums of only $1,000 to $2,000, while inflation over the past 50 years has increased over 600%.
During those same decades, the cost of living, employee wages, dental materials, laboratory services, equipment, technology, infection-control products, and operating a dental practice has increased dramatically. Although deductibles, maximums, and benefits vary by plan, many have not increased enough to keep pace with the actual cost of providing modern dental care.
If the original $1,000 annual maximum had increased along with inflation, patients would have considerably more coverage today. Instead, many patients continue to receive benefit levels similar to those offered decades ago.
Understanding Delta Dental’s Reimbursement System
Delta Dental does not determine reimbursement based on a dental office’s quality of care, the experience of its dentists and team, the amount of time devoted to a patient, the materials selected, or the laboratory used.
Under the Delta Dental arrangement applicable to our office, reimbursement is based on a tiered fee schedule established by Delta Dental. The fee level is influenced by factors such as the dental office’s network status and geographic location. This means reimbursement may be determined partly by the town or ZIP-code area in which an office is located—not by the quality of care provided to its patients.
Delta Dental establishes and periodically changes its participating-provider fee schedules. Dental offices do not control these reimbursement amounts, even while the cost of supplies, salaries, laboratory services, technology, and maintaining a dental practice continues to rise. Delta Dental does not provide a list of the fee schedule even if they participate.
Reimbursement for many services has decreased significantly during the past five years. During that same period, our costs for supplies and other essential practice expenses have increased substantially. Accepting continually reduced fees would eventually affect the time, materials, staffing, and resources we are able to devote to our patients.
Why Our Office Chooses Not to Participate
Our decision regarding insurance participation is not made lightly. We do not believe an insurance company’s fee schedule should determine the quality of materials we use, the laboratories we select, the amount of time we spend with our patients, or the treatment our dentists recommend.
Remaining out of network with most plans allows us to make treatment decisions based on:
- Your individual dental needs
- The professional judgment of your dentist
- High-quality materials and trusted laboratories
- Current technology and accepted standards of care
- The time required to provide careful, personalized treatment
- The long-term health and success of your smile
Patients with out-of-network benefits may still use their dental insurance in our office. Our administrative team will continue to help verify benefits, prepare estimates, submit claims, and provide supporting documentation. The amount paid remains subject to the terms, limitations, and fee schedule of each patient’s individual plan.
A Note About Not-for-Profit Insurance Organizations
Many Delta Dental organizations operate under a not-for-profit corporate structure. “Not-for-profit” does not mean that an organization has no revenue, assets, or highly compensated executives. Publicly available financial filings show that some Delta Dental organizations provide their senior executives with substantial compensation. Some in the Millions of dollars per year.
We share this information so patients can better understand that lower reimbursements to dental offices do not necessarily mean that the cost or value of providing quality dental care has decreased.
Our Commitment to You
Our responsibility is to our patients. We will always recommend the treatment we believe is appropriate for your health, clearly explain the associated fees, help you understand your estimated insurance benefits, and discuss available financial options.
Insurance coverage is a financial consideration, but it should not be the only factor determining the care you receive.