Patients always have this perception that dental insurance is really bad because there are copays for almost every procedure. The simple act of having to crack open your wallet to pay every time you need work done will certainly contribute to that perception.
However, what you need to understand is that it is fundamentally different from health insurance. It works in a completely different way from what you imagined.
The best way that Dr David Chen can describe how dental insurance works is as a punishment based system.
Are you ready for the truth? But can you even handle it?!
Dental insurance is based on a punishment system
The way dental insurance works is akin to a punishment based system. It will reward you for good behavior but punish you for bad behavior. As long as you accept and understand that, it will finally make sense.
Rewards you for good behavior
If you're diligent and go in for your dental check up and cleaning every 6 months, your insurance will reward you by fully covering the visit. That means the check up visit will be completely covered and you will have no copay.
Basically, those who go see the dentist regularly will most likely also care about their teeth more. They probably brush and floss more diligently. Insurance likes this behavior and will reward you for it.
Can you guess why they would do that?
It is because if you get a check up regularly your dentist is more likely to catch problems while they are small. Smaller problems require less complex treatments which are also less expensive. Essentially your dental insurance will save money the less problems you have and also the less complex the treatment that is required.
Punishes you for bad behavior
On the other hand, if you don't see the dentist regularly and you have a lot of teeth problems, your insurance will punish you for it with copays.
Basically if you need a lot of fillings, crowns, root canals, and extractions, you will need to pay for it. Your insurance frowns upon such behavior and they're not afraid to show it.
As an example, the bigger the dental problem the less coverage your insurance will give you. It may cover your filling at 80% but if you leave it untreated and it grows into a big cavity, you may need a root canal. That root canal coverage will all of a sudden drop down to 50% which is a lot less than the filling.
If you don't call that a punishment based system, we don't know what else it would be.
Evidence of a punishment based system
As an example, we're including what the benefit breakdown for a patient with cigna dental insurance looks like.
The percentages listed above is what YOU as the patient would be responsible for paying for each type of treatment.
Copayment percentage for each type of treatment:
Diagnostic and preventative (cleanings and checkups) have a 0% copay.
Basic restorative (fillings) have a 20% copay.
Major restorative (crowns) have a 50% copay.
Orthodontics and implants both have a 50% copay.
You can think of it this way, if you are good and go to the dentist twice a year and brush/floss twice a day, you shouldn't have any problems. If you have no problems your insurance rewards you with 0% copay.
However if you manage to get a small cavity and you need a filling, all of a sudden your copay increases to 20%. You've been bad so your insurance is punishing you for it.
Although if you choose to ignore that small cavity and it ends up needing a root canal or crown, your insurance will further punish you. They will increase your copay from 20% to 50% just to let you know that they are not pleased.
The moral of the story is that if you got that small cavity taken care of while it was a simple filling, you would've had to spend less money.
So, is dental insurance bad?
The million dollar question is... does that make dental insurance bad? Well in our opinion, it is certainly bad if you've been negligent of your oral health. If you brush twice a day and floss before going to bed, you most likely won't have very many problems. If you don't have problems your insurance will fully cover your visit.
However if you've been negligent and allow problems to fester you should expect to spend a lot more money on copayments for treatments. If that is the case we can certainly understand why you would think it is bad.