Why does dental insurance seem to cover so little?

Hello Everyone,

I went to the Dentist today and the news wasn’t good. I need two extractions, one root canal and two bridges. And yes, I do brush and floss daily, I’ve been cursed with very bad genetics when it comes to teeth. The total out if pocket is going to be close to two thousand dollars! Why is it that dental insurance never seems to cover very much, especially compared to medical insurance. I had my gall bladder removed and my deductible was only $150. What gives?

I guess it depends on the plan. Mine completely covers even routine visits (which actually seems strange as that’s a regular expense, but I guess they want you to go to catch minor problems before they become big. I did have two caps put on; one required root lengthening. I paid very very little for those as well. I think nothing, but I might have had a $50 charge or something.

Well the dental work is almost a sure thing that the insurer will have to pay.

Offset that though is that they may have less to pay out due to clients that do attend regular checkups so they encourage regular checkups.

Or regular checks are covered fully. The lack of coverage seems to be on any major work life root canals, crowns etc… This seems to be regards of the insurer. I can’t recall any plan ever passing much on the major items. Why isn’t dental insurance run more like traditional health insurance?

I’m think isilder nailed it:

Traditional health insurance makes money (and lots of it) on betting that the majority of their insured will never have a prolonged and expensive medical condition. But if you have dental insurance and have a bad tooth, your choices are a: suffer, b: get it pulled or c: get the root canal/crown/bridge/implant. If a person has insurance, they’re going for the third option, no question. And that means the insurance company has to pay. Since dental insurance usually doesn’t involve life or death situations, they know they’ll have to pay, so they set it up to minimize their loss.

Many people skimp on routine dental insurance. They might decide they need medical insurance for medical emergencies but decide that dental emergencies are rare and less serious.

So a lot fewer people get dental insurance (which creates a smaller pool of payers) and those that do buy insurance often do so because they have dental problems (which means higher pay-outs).

If you could get dental insurance that offered similar coverage to medical insurance (say covering all of a root canal except for a $150 deductible) most people would just not buy insurance until they needed a root canal. Then they’d buy the insurance and dump the cost on the insurer.

Given your difficulty with dental anesthesia (discussed by OP in a previous thread), your OP here sends shivers through my molars!

GFL with all that, obbn!

{{{ Cringe }}}

They do pay, but it’s usually at absurdly low rates that seem to have been set in 1970. Like say… $200 for a crown, when your average crown costs $1000, and stuff like that.

What I learned in my class on insurance theory:

Most people who purchase dental insurance plan will use it. People will especially put off purchasing dental insurance until they are pretty sure they need some expensive work done. People who get dental insurance through work will start going to the dentist more often, and will often try to get things fixed that they have postponed for a long time.

This makes it pretty hard for insurance companies to offer comprehensive dental insurance at a reasonable cost. So instead, you see high premiums and/or high coinsurance requirements.

I just looked online, and a root canal by a Harley St dentist (non NHS) would cost around £500. Dentists do pretty well in the USA I guess.

You and me both. That’s the first thing that went through my mind. The Dentist is sending me to a specialist and you bet I’ll be covering my anesthesia issues in detail with him/her. God I hope they can put me under and control the pain when I wake up. I hate to sound like a sissy, but I’ve had enough pain for one lifetime.

Oh and as a bonus it isn’t just dental anesthesia, I had my gall bladder out and the surgeon told me the anesthesiologist was afraid he was going to kill me as it took do much to out me under. The doc said everyone in the OR was sweating bullets. At least I make it interesting for them!

That’s the case for me. My dentist likes to say that my teeth are “like rocks”. The amount we were paying out every year for dental insurance was just not cost effective for office visits, and prorated over time would have been far more than we would ever pay for the occasional crown or filling. So we operate on a cash basis.

The main difference between Dental and Health insurance, is that there are rarely (or never) dental emergencies in which the patient immediately needs expensive treatment for a life-threatening event. If an ambulance rushes you to a hospital, the choices are often 6-figure heroic procedures, or death. With a dental condition, you can wait till Monday and get at least temporary relief for a couple hundred bucks.

That means there are reasonable alternatives to Dental Insurance, with names like Progreso and Algodon, which can re resorted to at about one fifth the price, more or less at the leisure and convenience of the perfectly ambulatory patient.

well teeth are relatively small so why shouldn’t the coverage be?

i recall that years back an annual checkup and cleaning were recommended, insure covered it. then annual checkup and semi-annual cleaning, insure covered it.

seems to favor prevention.

You don’t really need dental insurance. How often do you need dental work right now and can’t get the money? Probably not very often. Most likely, you can pay for the work immediately or put it off until you can save up for it.

It’s a mistake to get insurance for things which you’re going to pay for it anyway. Your premiums will end up costing the price of the service plus extra to pay for the insurance infrastructure. It’s a different story if your employer is paying for it. Then it might make sense because they are covering some or all of the cost.