So, a question we often get is, “Why are you guys not on my insurance?” Or if I call the office, “Do you take insurance?” Or “Why has my insurance not paid for everything?” These are all great questions, and one of the things that is really a big topic in dentistry right now is insurance and whether your dentist is in-network or out-of-network.
One of the things I decided when I started this practice was I wanted to focus on patients. I wanted to focus on their needs, and I wanted to be the one in charge of deciding what treatment was the best and what the plan needed to be. And I didn’t want to let outside people tell me how to take care of my patients.
Unfortunately, when you’re in-network, meaning when a dentist is in-network or is on your plan, a lot of the decisions that are made are kind of driven by what’s compensated by the plan, what the plan is going to allow you to do, and the time you have to go between treating patients. Unfortunately, a lot of times in today’s economy, if you’re on insurance plans, you have to see a lot more patients to make ends meet, to kind of meet your finances.
Fee-for-Service Model
So I decided that being fee-for-service basically means I’ve got a set fee for all our procedures, no matter who the patient is. And if you have dental insurance, absolutely, we will do everything we can to maximize your dental insurance. We’ll file it, we’ll write narratives, and we will send all the supplementary information, x-rays, and narratives to make sure you get your full reimbursement of whatever insurance plan you have.
But that allows me to be in control of what the best treatment plan is going to be and how to take care of you in the best way.
How Dental Insurance Hasn’t Kept Pace
So the practice that I purchased has been around since 1972, and one of the big advantages of that is I can look back through the records and look back through their finances. And I got a really cool introspection into kind of the trends in dentistry and the economy in general.
So back in the early seventies, the average insurance covered about $1,500 a year. And then back in that same timeframe, the average house was only about a hundred thousand dollars, maybe even less. Fast forward to today, the average house is about 300 to $400,000, and insurance is still only covering around $1,500.
The Impact of Inflation
So, if you think about it, think about how much everything has changed in the last 40 to 50 years and how much the cost of everything has gone way up. Gas was 30 cents, eggs were 50 cents, and now everything is so much more expensive, but insurance is still only covering the same number.
And so to me, it made more sense to provide my patients with the care that they needed, and we will figure out, if you have insurance, great, we will help you maximize that. But I didn’t want to be beholden to any other company and even someone who doesn’t know dentistry and doesn’t know your mouth kind of guiding our treatment plan.
Frustrations with Dental Insurance
Delays in Treatment
A great example of these frustrations that we deal with is some insurance plans won’t let you get, say, a root canal unless you’ve been on their plan for six months. If you’re in pain, you don’t want to wait six months. The damage that can do, not only to the mouth but psychologically, just being in dental pain, but the long-term health of your mouth is really important to address those needs right away.
Restrictions on Replacing Missing Teeth
Some dental plans, if you’re missing a tooth, they won’t pay to replace it, and that just seems silly to me. And like I said, we’ll absolutely work with your insurance company to maximize those benefits.
Limited Coverage for Cleanings
Another example is that some insurance benefits will only pay for having your teeth cleaned twice a year. For the majority of people, that’s totally great, but there are some patients who need to see us every four months, whether it’s periodontal disease or your mouth is just more prone to making more calculus and plaque. There are certain situations where your health needs to be addressed in a different way than their cookie-cutter insurance plan.
The Benefits of a Fee-for-Service Approach
So these are all examples of why we’re fee-for-service, and I feel that’s the best way for me to be able to take care of my patients.
If you want to come to a dental office that cares about your individual health and your mouth and is not beholden to the insurance companies or anyone else kind of telling us what to do, come visit us. We take your health very seriously, and we’re going to build a plan that’s custom for you to make sure you keep your teeth for a lifetime.
If you think about it, your teeth have a massive impact on your everyday life, and they play a role in your health and overall happiness.
So, no matter where you are and what insurance you may have, come see us. We’ll work with your insurance. We’ll make sure we maximize your benefits, but we’re going to take care of you and put you first.
Conclusion
I’m Dr. Brett Langston. I’m a prosthodontist. I’m the owner of Dental Implant and Aesthetic Specialists here in Brookhaven, Georgia, and I’m here to help you watch your mouth.