Having been in practice since 1975 (yes that is 40 years), I have seen the good and the bad of Dental Insurance. First the good: when it started to become popular in the early 70’s it provided good coverage at a reasonable cost. In fact Delta Dental was started and promoted by Dentists as a good policy to compete with the other insurance industries offerings. It was the gold standard that all other policies were measured against.
A typical policy covered $800-$1000 per year at 100% preventative
It also put the UCR fees at the 95th percentile. Meaning, the allowed fee was what 95% of the dentists charged. Everyone was happy, the patient had good coverage and the employer (who paid for the insurance) had happy employees, and the Dentists got a fair fee for their work.
Now let’s flash forward to today, to begin to see the bad. That same policy by Delta Dental (which, take note, is no longer owned by Dentists, the current CEO is not a dentist, rather, has a degree in public relations) still has the same $1000 yearly maximum with 80% restorative and 50% for replacement. The URC (usual, reasonable and customary) fees have changed from the 95th percentile, to the 90th, to the 80th, to the 70th and in many cases now to the 50th percentile. You see the insurance company has changed the definition of what is usual to suit their bottom line, DUH!!!! I wonder what else they have done to increase their bottom line? By not increasing the yearly max, the insurance industry has frozen the amount they have at risk. Taking into consideration yearly inflation, at an average 3-5% a year increase, that $1000 yearly maximum should be $6000-$8000 by now. However, insurance maximums have held steady over the years at $1000 a year (with the exception of a few plans that offer $1500 maximums), which is 4 to 5 times less what inflation should have made it.
If I was an employee with Delta Dental insurance, I would be upset. And that is not all; stay tuned to the next installment of how the insurance industry is changing dental care and the dental services that are rendered.