The Games They Play

Why do the dental insurance companies want me to lose my teeth?

This may seem like an odd question but it seems like they really do want you to lose your teeth. After all, their services don’t quite meet our needs completely. So where is the problem rooted?

Well, to begin with, the insurance companies are there to make a profit — only to make a profit. I do not blame them for this. Businesses need to be financially stable and reasonably profitable in order to continue providing services.

But here is the rub: to gain profit, they need to either collect more money or spend less money. This means they are in complete conflict with paying for patients’ dental care. It is a delicate balancing act between how much they have to pay out to keep the majority of the subscribers’ content. This is you and your company, because you would not knowingly want coverage if you had to pay extra for care, yet your employer would certainly want to see his employees satisfied with their benefits. So the insurance companies need to pay out just enough to keep everyone satisfied, while still making a profit.

You see, they are in an indirect conflict with providing care for you. They manage this by rules and regulations customized for each plan or for each employer. For example, one plan may pay for crowns without a wait time, but another may require a wait time. Consultants are paid to review the treatment, but these are often lay people that have no credentials at all and are not qualified to make dental decisions. When a particular claim comes up for debate, they then bring in a dentist to review it. Like in Las Vegas, “the house always wins.”

Insurance companies will use the power of the printed word to confuse you and escape from covering your claims. They will insinuate that your procedure is not covered, and, therefore, you probably should not have it done. The onus of responsibility of the insurance companies to pay is relieved and future financial problems are avoided. They will also deny services randomly because there are a percentage of people, vulnerable to either ignorance or the companies’ deceit, that do not fight back.

So how can you as the consumer win this game?

1. Do not consider the insurance company your friend or a source of dental wisdom.

2. Develop a health model with standards for your body. This can be done with the help of you dental health practitioner. You should ask the questions about what you need to do to be 100% healthy.

3. Accept the fact that you do not have dental insurance but only a dental benefit.

Remember, be true to your teeth and they will be true to you. Or just floss the ones you want to keep.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com