The cost of dentistry can be high, and many people only see dentists who are part of their own insurance plan. But Dr. Bart Kreiner, who runs his own dental practice, Dr. Kreiner Family Dentistry, in Bel Air, Maryland, talks here about why it can make sense to visit a non-participating dental insurance office.
The insurance companies set the fees that a participating provider can charge. And it’s the insurance companies which then set those fees based on what they think is clinically acceptable treatment. But in my opinion, they do not always know what is actually clinically acceptable, or best for their patient’s own individual needs, and what is not.
My belief is that the patient should be offered all treatment options, including doing nothing. The dentist should be able to explain all risks and benefits, and then let the patient decide what is best for him. It should not be a case of the insurance company saying, “Well, this is all we are going to pay for.” Although we ourselves are not dentists, we know best what is right for the patient - although we have not see him - and this is all we will prescribe.
Gum Disease Patients
Here is just one example: An insurance company typically will only pay for two professional dental cleanings a year. This is acceptable for patients who do not have any gum disease. Unfortunately, though, more than 75% of our population has some form of gum disease.
So this would be potentially be under treatment for all those who have gum disease. If we only do what the insurance pays for, we can still end up losing teeth.
Not Participating Provider
I have patients with have insurance who come to me, but I am not signed up as a participating provider. That means that they pay their deductible and copay, and the difference between what I charge and what the insurance company pays. That is an out-of-pocket expense, so it potentially could be more expensive to see me than if they go to a participating provider.
But I maintain that this way, the patients are getting best value for money, and taking care of their teeth in the best way possible, even if they have to pay more themselves. What it all comes down to, in the long run, is priorities and more importantly, keeping teeth.
The information in the article is not intended to substitute for the medical expertise and advice of your healthcare provider. We encourage you to discuss any decisions about treatment or care with an appropriate healthcare provider.
