Dental insurance is complicated. Annual maximums, benefit periods, exclusions, participating versus non-participating, usual and customary, claim submission, narratives, explanation of benefits, deductibles, coverage levels, and writeoffs. Through all the complexity, hundreds or thousands of dollars of each patient's household budget are at stake.
Many insurance companies provide ready access to details of patients’ insurance benefits. Rather than assume each patient has generic benefits, dentists can leverage insurance benefit information to design treatment plans that better leverage patients’ dental insurance benefits. By taking account of variation in patients’ insurance benefits, dentists can produce one hundred or more dollars per day of highly profitable dentistry while providing better dental care to patients. Just one hundred dollars per day adds $10,000 or more profit for the dentist over the course of a year. What’s best, insurance companies pay for the extra production.
While insurance benefits would be irrelevant in a utopian world of “ideal treatment”, financial considerations are relevant in the real world. If economics were irrelevant, why would so many people – especially in poorer countries - continue to walk around with imperfect smiles? Why would employers put so much money and effort into providing dental insurance benefits? Why would patient financing programs such as Care Credit exist? Why would Americans seek dental care in Mexico or other countries?
The principle of Patient Autonomy in the ADA Code states, “The dentist’s primary obligations include involving patients in treatment decisions in a meaningful way, with due consideration being given to patient’s needs, desires, and abilities.” Finances are not only a justifiable, but a required consideration for dental treatment under the ADA Code.
With detailed information about patients' dental insurance benefits, dentists are armed to provide optimal care for real-world patients who face constraints on their household budgets.
