How Does Dental Insurance Work?

How is Dental Insurance Different Than Medical Insurance?

The idea of any type of insurance is to spread out risk among a group of members, so that if a large, unexpected expense is incurred, you as a member are “insured” against having to pay it all out of pocket. This is why most people choose to buy health insurance, to act as a “stop-loss” in the case of an emergency or illness, when medical bills could add up to the tens or even hundreds of thousands.

Dental insurance offers no such protection, since it works more like a coupon, giving you just enough credit for a couple exams and cleanings and maybe a minor procedure or two. As opposed to how medical insurance treats most emergencies, dental insurance almost always caps coverage well below the cost of treating a major dental problem.

When dental insurance began to be popular in the 1970s, annual maximums were set to about $1000. Today, most plans still have a yearly maximum between $1000-$2000, despite inflation reducing the value of that benefit by about ten times!

And if you are purchasing your own dental plan (as opposed to getting a group plan from an employer), you may find that you end up paying much more for your annual premiums than you would have paid out-of-pocket for dental care with no dental insurance! This is especially true since most individually purchased plans include a long waiting period before treatment is actually covered, along with having other restrictions.

Learn more about the types of dental insurance and how to avoid choosing a misleading or essentially worthless plan.

Hidden Fees, Upgrades, and How Insurance Gets in the Way of Price Transparency

Dental insurance contracts usually work like this: A dental insurance company asks the dentist to give a discount to their members in exchange for the promise to send them more patients. Over time, as dental insurance companies have become richer and more powerful, favoring large “chain” dental corporations over dentists, the terms of these contracts have become increasingly disadvantageous for any dentist who prioritizes quality of care.

Since in-network dental insurance reimbursements are often lower than the actual cost of providing a dental service, especially on HMOs and other lower-tier plans, many dentists feel pressured to increase fees for uninsured patients to make up for the losses, spend much less time with each patient, or find creative ways to provide more aggressive treatment, including out-of-pocket “upgrades” and extras that the patient must pay for. This can leave patients feeling “nickel-and-dimed” and distrustful of their dentist.

Even if a dentist manages to overcome these challenges and provide all patients with quality dental care, the fact remains that some patients pay much more than others for the same service, based solely on their relationship with a dental insurance company.

It is for these reasons and many more that we have decided to be out-of-network with most dental insurance plans.

By refusing to give arbitrary and unrealistic discounts to certain insurance companies, we are able to reserve discounted and charity dental care for those who are truly in need, while maintaining a very high standard of care for all patients.

What Wave Dental Is Doing to Help

In this difficult time, many Americans have found themselves unemployed and uninsured. We want to do our part in easing the burdens of those affected by the pandemic in our community by offering several options.

Wave Dental Membership Plan

• Wave Dental’s In-Office Membership Plan is perfect for patients who do not have dental insurance. For less than $30/month, patients receive two exams and cleanings, with any required x-rays included, a discount of 25% on treatment, and more
• The Membership Plan is not dental insurance, and therefore does not have frequency limitations, pre-existing condition exclusions, waiting periods, annual maximums, or deductibles
• Family plans are also available!
• Learn more or sign up for the plan here

Financial Assistance Program

• We have partnered with local non-profits to provide heavily discounted care to qualifying families, based on income and other factors, after a financial coaching interview with the organization
  Special availability to patients affected by COVID-19
• For patients who do not qualify or still have no ability to pay, our staff will work to help you schedule an appointment with a federally funded dental clinic or other local charity to ensure your needs are met at little or no cost
• Please contact our office to apply

Zero Interest Financing Options

• We work with CareCredit and other companies to offer financing to patients with qualifying credit, often at zero interest
• Our staff can help you apply and find out if you qualify in minutes

Thank you for reading, and please feel free to reach out with any questions.