Editor’s Note: “Ask the Dentist With Dr. Clarke Woodruff” is a monthly column about dental health and information writtten by S. Clarke Woodruff, D.M.D., whose practice is located at 800 Main St., Hellertown, Pa. This is the second installment in a two-part series about understanding dental benefits. To read Part 1, click here.
In Part 1 of this column, I discussed the difference between dental insurance and dental benefits, and why understanding that difference is important.
A dental benefit package is a contract based upon the fee schedule the insurance company creates. They say the schedule is based upon zip codes and what the usual fee is for that area. Now, in order to increase profits, the insurance company will create a fee schedule that in fact represents only a percentage of the customary fee. They then base the reimbursement upon that fee schedule. Their fee schedules are typically 75 to 40 percent of the normal fee for that area. For example: Dr. Z charges $950 for a crown, but the dental insurance company pays on a fee of $650; a substantial difference. So that doctor has to settle for that payment if he is a participating doctor. If he does not participate, the patient must make up the difference. The patient must decide if the relationship they have with that dentist is worth the extra fee. Is that doctor more highly skilled and is the outcome substantially better? Remember, we get what we pay for. Not all doctors practice at the same level of expertise.
That truism brings up the whole participation/non-participation debate. Some doctors participate with every insurance plan, and some doctors do not participate with any carrier, and everything in between. Why would a doctor participate if they are losing up to 40 to 50 percent of their normal fee? “To stay busy,” in one simple phrase. That doctor has to figure out a way to provide the service and do one of several things. They would have to find a way to do it cheaper, and that means possibly using cheaper material and laboratories, or do it faster and rush through the treatment. All of these tactics potentially could adversely affect the final quality and outcome of the procedure. The final tactic is to not make sacrifices in materials, time and laboratory use, and accept that the profit margin for that procedure is substantially lower. Now you have an insight into the decision a dentist must make about insurance plan participation.
Dental benefits are a great tool for helping many people who could otherwise not afford dental care, receive it. But don’t let your dental benefits drive your decisions about seeking dental care. Remember that no one cares more about your dental health than you and your dentist. The insurance companies only care about one thing, and that is to make money. Be thankful for the benefit that you have.
Clarke Woodruff has lived and worked in the Lehigh Valley most of his life. He left the region to complete dental school in Philadelphia and to serve four years as an officer/dentist in the U.S. Air Force. A member of Freedom High School’s first graduating class, Dr. Woodruff earned his undergraduate degree from Lehigh University. He received his Doctor of Dental Medicine degree (D.M.D.) from the University of Pennsylvania in 1976 and opened his Hellertown dental practice at 800 Main Street, Suite 102, in 1980. He was named a Fellow of the Academy of General Dentistry in 1987, after successfully completing a comprehensive examination and more than 500 hours of continuing education. Dr. Woodruff maintains active membership in the American Dental Association, Pennsylvania Dental Association, Lehigh Valley Dental Society and American Academy of Cosmetic Dentistry. In addition to his private practice, Dr. Woodruff is devoted to the education of tomorrow’s dentists and as such is currently chair of the Department of Dental Medicine, Lehigh Valley Health Network. His outside interests include vintage race cars, woodworking and singing. Find him on Facebook and check out the blog on his website, here. For more information or to schedule an appointment, please call 610-838-6597 or contact him via email.