Wednesday, July 27, 2016

Dental Insurance Rip-Offs… Consumers Beware!

imageDr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email:

  Dental Insurance Rip-Offs… Consumers Beware!

One of the biggest scams facing dental consumers are products sold to them, which are misrepresented or falsely presented as dental insurance. The reality is usually quite different. Other times the product sold to the public is truly dental insurance, but it has virtually no value or entirely no value to the consumer. The bait presented to the potential dental patient is low- cost monthly payments for insurance. Unfortunately in too many cases, the dental consumer is hustled out of their money with little or nothing to show in cost savings or benefits.

Bogus Dental Insurance Plans
There are swindlers who sell consumers all sorts of insurance plans for low-cost monthly payments. Sadly, the plan administrators failed to secure the services of any healthcare providers, assuming these bogus insurance plans even have an administrator. All legitimate dental insurance programs must be registered within the states they do business within. They must comply with each state’s rules and regulations for dental insurance. A check with your state insurance commission will provide you with a listing of all duly and lawfully registered insurance providers. If the dental insurance company providing the plan isn’t listed, that’s a red flag warning. Stay far clear of that company.

Discount Programs
Discount programs for dental services are too often presented in a deceptive format, which gives the impression of dental insurance. For that reason, numbers of states have outlawed these discount plans. In no case are these dental discount plans regulated by the state insurance commission. However, numbers of state attorney generals have attempted to close down these dental discount card programs, in service of the public interest.

Some discount dental programs are sold by independent companies, with little or no background history available. They may or may not even have enrolled dentists, who participate and honor their discount cards. Too often, the few dental clinics which do accept these discount programs artificially inflate their fees, to offset any consumer savings. Other dental clinics find these discount plans work to get customers in the door, for more profitable bait-and-switch scams or hard-sell upselling of additional services. Unfortunately, consumers attracted to purchase these discount cards are frequently financially disadvantaged, and not particularly sophisticated in dishonest business dealings. They are primed for the plucking.
Large corporate dental clinics also sell dental consumers a variety of discount dental plans, which are administered under their company. Again, numbers of states have outlawed these plans, because they too closely resemble lawful insurance programs, which they are definitely not. Some corporate dental outfits manipulate and misrepresent their fees in a variety of ways, such that patients purchasing a discount plan actually may have no cost savings, or actually pay more, than patients utilizing standard dental insurance.

Sales of dental discount plans have become so lucrative, that bonafide dental insurance companies have entered into this racket. It’s highly profitable for them, as they don’t need to register these plans as insurance vehicles with any state regulatory commission, and they aren’t as subject to state or federal auditing. Moreover, these discount plans cost the insurance company no outlay of expenditures for patient dental benefits. Since there is no remuneration paid to dental providers by the insurance company (only a promise by dental clinics to discount fees), the insurance company has little incentive to monitor or audit billings from dental providers. Unfortunately, too often the same bait-and-switch and hard-sell upselling we see with corporate dental clinics, also happens with dental clinics accepting dental discount cards sold by an insurance company. Once again, consumers get screwed.

Dishonest Dental Insurance
Dishonest dental insurance has become a highly popular swindle, especially since the inception of the Affordable Care Act (ACA) and the various state insurance exchanges. Yes, these are genuine dental insurance programs, many of which are specifically designed to cheat consumers. With all the new changes in the insurance industry, many state regulators are ill-equipped to provide appropriate oversight. In this deceitful quagmire of the insurance industry, consumers are at risk. Let’s examine some of the more popular methods of gaming dental patients.

Numbers of health insurance companies today sell dental insurance at an additional upgrade fee. What often isn’t disclosed to the plan purchaser is that the dental coverage is fully embedded in the medical insurance plan. The consumer is sold on dental insurance, which covers preventive dental services, along with many restorative services. What isn’t disclosed is that the consumer often must reach the medical deductible limit of $5-6,000, before they become eligible for dental benefits.
Other consumers are sold medical insurance along with embedded dental insurance for an added cost, which becomes immediately in effect. Unfortunately, what often isn’t disclosed to the consumer is that the plan may only cover for persons under age 18 (pediatric dental plan). Far too many adult singles and adult couples have been hoodwinked by such insurance offerings.

Most recently, consumers have been purchasing dental insurance plans which offer very extensive dental coverage. What often isn’t disclosed is that consumers must pay premiums for 12 months, for eligibility to obtain these dental benefits. By that time, the plan may be discontinued. In the meantime, the plan enrollee may enter a dental office to obtain an examination. What the insurance plan fails to adequately disclose is that, a complete series of radiographs which is essential for a proper examination, is not a covered benefit until the 12-month grace period (waiting period) expires. During this grace period, the only covered dental benefit may be a limited number of dental exams (two), and 4 bitewing x-rays. Proper diagnostic x-rays, fillings, root canals, extractions, crowns, and removable prosthetics, etc. are not a covered benefit until the 12-month waiting period has expired, assuming the insurance company hasn’t discontinued the specific plan during the interim time.

Consumers cannot depend on government regulators to maintain a fair and equitable marketplace. Even prior to the implementation of the ACA and healthcare exchanges, state regulators were overworked and overextended. Today, the situation is worse. Consumers largely are operating in the dark, and may be dealing with dishonest sharks.

The author strongly recommends consumers establish a positive relationship with someone they trust in the dental profession. By and large, the public can’t negotiate the ins and outs of dental insurance without assistance. It’s too complicated. It’s often intentionally made complicated to confuse and cheat consumers. Dental benefits highlighted in large bold print may not fully disclose a series of exclusions, grace periods, deductible limitations, maximal yearly allowances, etc. Dental insurance consumers are at a distinct disadvantage.

A trusted dental professional is well aware of all the scams reported in this article and many more. Believe me; this report has only skimmed the surface of the numerous pitfalls associated with dental insurance. A trusted independent dentist (one not associated with corporate healthcare) will generally be very happy to review your dental insurance plan (assuming it’s truly actual dental insurance, which they can sort out as well). You work too hard to earn your money, to see it wasted on Wall Street fat-cats, who run these deceptive industries.