Use it or Lose it: Playing the Dental Insurance Game…

It’s that leaf dropping, pumpkin spice flavor, sweater wearing time of year that’s upon us. Fall is in the air as well as using your end of year dental insurance benefits. 

Dental insurance companies hang this theme over the insured heads – you pay us to have insurance, we will pay back minimally AND if you don’t use the present benefit, we will take all the remaining and you will lose all remaining benefits for the year! It sounds daunting, yet it is how the insurance companies actually work.

AMP teaches by late summer or early fall to reach out to all active patients who could still benefit from using their remaining balances before they are irrecoverable at the close of the calendar year. Specific narrative training is important to put needed dentistry on the books. Most teams do this quite successfully.

Dental Insurance food for thought

For those patients in network with their PPO and struggle to get their needed dentistry completed because “they ran out of benefits” are the very patients STILL COVERED. Here is how this works. Once the maximum benefit is used, the patient still enjoys a discounted fee on all procedures if they are insured. Let us say that again. The patient has benefits after their maximum. 

Example – the UCR for a prophy is $100. Your PPO discounts this prophy fee to $70. That’s a 30% discount! YOU CAN HAVE YOUR TEETH CLEANED 10 TIMES OR MORE A YEAR FOR $70 each with the first two covered by insurance. Do this math – Your first two cleanings cost you nothing (not really, you must pay to have the coverage) although your out-of-pocket expense is zero. The next two cleanings cost you $70 each, or, $140. Take the $140 you spent over a year of 4 cleanings. This averages out to $35 per cleaning. 

Why would someone want to do this?

Here is why -

• The patient benefits by maintaining a healthier periodontium because they are seen more often
• The provider benefits from a more frequent interval, allowing the patient to maintain a better health standard AND the provider doesn’t ‘push’ to do more than intended for the time allowed
• The office benefits from future chairs filled more often. Hygiene tends to grow faster with this model.

Although we have mentioned two dynamics here; 1. Use your insurance or lose it, and, 2. Your in-network provider will continue to offer you a discounted fee as long as you are insured. Why both?

If your dental health requires repair and you choose not to address this ‘until next year’s benefits,’ you could cause bigger and more expensive dentistry to be done. Dental decay NEVER heals itself. It is always best to fix a tooth at the earliest possible time; when the decay is small and the tooth is still strong. Delaying treatment for insurance reasons, or, any other will cause decay to grow. These costs the health of your tooth and a deep dig into your wallet. 

Use your benefits up.
And remember, get all your dentistry done at the earliest time possible. Your next steak meal will thank you!