Defined Dental Benefit Plans: Why Insurance Does Not Exist

Dental "insurance" does not, has never, and never will exist

Dental "insurance" has been around for the entire life of a very large proportion of dentists practicing today. It is part of the fabric that makes up healthcare in the United States; as as such, it is not going to go away completely or quickly.

Given that reality, many, if not most dentists will decide they need to be part of one or several defined dental plans. The decision whether or not to be part of these plans is one that each practitioner makes when he or she owns a practice, but it is one that is made for the doctor in most associate positions and virtually ALL corporate dentist positions.

The distinction between these defined dental benefit plans and insurance is something that every dentist and every patient who is part of a defined plan needs to understand and learn to utilize to their best advantage. For some patients, the advantage will be cost, for others, health, and for still others, cosmetics. The most important part of any relationship is honesty, and moving ahead in a relationship where each of the parties sees, feels and thinks differently about any part of that relationship can lead to a less-than-pleasant termination of it. This is especially true when money is involved.

What are defined dental benefit plans about?

Insurance is by definition protection from unexpected and catastrophic loss. Homeowner's insurance is a good example. You buy a house, you establish the value of it in today's dollars through your purchase, and you insure that value against its loss taking into account the value increase over time. The insurance is specifically designed by you, based on what you need, and what you choose. All insurance is about an individual (or family), what that individual has, what that individual needs. It is conceived and designed by you and for you.

Insurance is absolutely all about what you need.

A defined benefit plan is about what someone else chooses for you. This in no way diminishes the potential value to you as an individual, but it is not about you, it's about a benefit someone gave you or you purchased for yourself.

Defined benefit plans are absolutely all about what someone else chose to give you.

Defined dental benefit plans are not about individuals and what they need to be healthy. They can be a tool in maintaining whatever level of health you choose, but they are not now and never have been designed to get you healthy.

Defined dental benefit plans provide a list of services at a preset cost and then pay all or a portion of that cost. If you need a service not on that list, you don't get any help in covering the cost of that service from them because they did not choose that as part of their list of defined benefits. This is not a bad thing, it's just a thing. These plans are perfectly designed to do exactly what they do: pay for some things that you may or may not need up to a limit that is also preset, and specifically not pay for some things you may or may not need. You must decide what you need.

Another way to think of defined dental benefit plans

If your kitchen sink leaks, requiring some repairs to the cabinets, you need some cabinet damage repaired. That damage is a covered expense on your homeowner's insurance and the insurance company provides for the repairs. If you have a "defined home benefit plan," this is exactly the kind of thing it was designed for. It will repair the damage in a way that is within the limits established when they decided what to give you (of course there is a co-pay). Excellent.

If your home explodes and burns to the ground, your need is obvious, you need a house. Your homeowner's insurance will build you a house. The type of house and what goes in it was determined by you when you designed and bought the policy. If you have a defined home benefit plan, it was never designed to build a house (to get you healthy), but it will contribute toward the construction of your house (your health) up to the limit that it established when someone chose what to give you. You get a check for $1,500 and it pays the cost of cleaning the windows twice a year. Excellent.

If you don't like the look of your house and want to make some esthetic changes, you already know where that funding comes from. It is never part of a homeowner's insurance policy or a defined home benefit plan because it is something you choose for yourself and pay for. It's why esthetics are so easy to discuss with patients: there is no dichotomy of how it is seen by patient and doctor.

Helping patients understand the difference

The problem with the above situation is that most patients and most dentists have never discussed the reality that is the defined dental benefit plan and how it fits in with what each patient really needs and really wants. Patients have been told they have dental insurance; that belief is often reinforced by the dental practice when the first things the patients are asked by the practice is, "Do you have dental insurance?" We have participated in this dichotomy of understanding by being part of it through our interactions with patients.

If you click on this link, "Dental Insurance or Dental Assistance," you can download a form that I have used in my practice for my entire practice career. It is a sheet that provides talking points and explains what we know about the patient's defined dental benefit plan. It asks patients to claim what they want, what they need, and to build a partnership with us to get those things.

I believe that casting the benefit plan as an evil can do more to undermine the developing relationship than build it. Patients come to us as they are, and acceptance of that has made it possible for me to do some extraordinary dentistry with people who came truly believing that they only wanted what their "insurance" would pay for. As they learned that they were in fact the master of their own health, unbound by the decisions made by someone else about what should be available to them, many saw themselves differently, their dental health choices differently, and the assistance offered by their defined dental benefit plan differently. It starts with an open and honest discussion. In my experience, that has been the genesis of a lot of fun, a lot of dentistry and the most exceptional relationships anyone could hope for.

(Click this link for more dentistry articles by Dr. Gary DeWood.)

Gary DeWood, D.D.S., M.S., Spear Faculty and Contributing Author