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#7 Who's Who in the Dental Office? Part 1 - The Business Team Talks Dental Insurance
Last week we talked about the various positions that make up a dental office. There were quite a few followup questions asking us to expand on some of the job descriptions. So, we decided to start a series of “who’s who in the dental office”. This will be a 3 part series and we are starting off strong with the business team. This week Bonnie Kost is joining us and talking about all things related to dental insurance. She explains the difference between medical insurance and dental insurance, dives into some insurance nuances to look out for when choosing a dental plan, and gives you some tips to help you maximize your benefits. You don’t want to miss this episode!
As always, feel free to reach out through our instagram @YourDailyDoseOfDental or through our website http://www.DoseOfDental.com. We would love to hear from you and hope your questions can be featured on our show!
Instagram: https://www.instagram.com/yourdailydoseofdental/
Website: https://doseofdental.com/
TikTok: https://www.tiktok.com/@dmadentist
Ashley 00:00:02
Welcome to DM, a dentist, your friendly neighborhood podcast, where doctor Rusty and doctor Mike are here to make dental care approachable for everyone because everyone deserves a healthy smile without the fear.
Dr. Mike 00:00:24
Alrighty, so I have Bonnie with us today. Say hello, Bonnie.
Bonnie 00:00:28
Hello. Well, hello, everyone.
Dr. Mike 00:00:29
This is Bonnie. She’s been working in dental for how long now?
Bonnie 00:00:33
About ten years now. I started in the back.
Dr. Mike 00:00:36
Start in the back.
Bonnie 00:00:37
We talked about that last week.
Dr. Mike 00:00:38
So what is back?
Bonnie 00:00:40
Back office is being a dental assistant, being a hygienist, being a dentist. So front office does everything up front. So we push the paper and do all of the insurance and scheduling, and back does everything else for us.
Dr. Mike 00:00:58
So, yeah. Like clinical versus business team.
Bonnie 00:01:01
Yes, absolutely.
Dr. Mike 00:01:02
So, yeah, Bonnie’s been doing this for a while, so we had her on the show. I know we talked about last week, what are the different roles in the dental office? And this week we decided, why not talk to someone who does it for a living?
Bonnie 00:01:13
I do do it for a living. I am technically a finance coordinator, which is a fancy way of saying, I tell you how much everything’s gonna cost.
Dr. Mike 00:01:22
So you would say you are well versed in the insurances, eh?
Bonnie 00:01:27
I have so much knowledge of insurance that sometimes it hurts. There are thousands of different plans out there, and our goal is always to know as much as we possibly can in order for our patients to get the most out of their benefits.
Dr. Mike 00:01:43
And it’s hard. Cause it’s always. You were saying earlier, it’s always a moving scale, right?
Bonnie 00:01:47
Yes. Sometimes it does feel like we’re on a little bit of quicksand. Like, say anything is an absolute, and it changes every January. So every January, we have a big push to rediscover every dental plan that we have coming into our offices.
Dr. Mike 00:02:09
That’s wild. So they change a lot.
Bonnie 00:02:10
They change quite a bit, actually. And I will call it frustrating, but it’s also, you know, that is just how our country is ran with dental insurance currently.
Dr. Mike 00:02:23
And the bad thing is I will do things in the back and, like, treatment plan all these things and get all excited, and then I’m like, oh, it’s probably covered. Who knows?
Bonnie 00:02:32
And it’s not.
Dr. Mike 00:02:34
So I’m the one that gets Bonnie in trouble, but he does quite a bit. Hey, we’re very good friends, so I’m allowed to do that.
Bonnie 00:02:39
Yes, absolutely.
Dr. Mike 00:02:41
Okay, Bonnie, let’s dive in. So the one thing that gets me into hot water as the dentist is I don’t know much about dental insurance. That’s why Bonnie’s here.
Bonnie 00:02:48
Yep.
Dr. Mike 00:02:49
And I think it’s good. I don’t like, I’m here to give the clinical side of things not necessarily be dictated by corporate America.
Bonnie 00:02:56
Thank you. Yep. And I do, I do actually prefer it that way. When I am looking for an office to work at, I, while it’s nice for the doctor to acknowledge costs of things, I think their job is to plan the best smile for you and whatever that looks like. And we can always come up with alternatives, but the dentist should not be even considering cost because it changes how they do things. And we want what’s best for each person that comes into our offices.
Dr. Mike 00:03:29
Right. We want what’s best for you. So we’re not going to be driven by insurance.
Bonnie 00:03:33
Exactly.
Dr. Mike 00:03:33
We want you to maximize your benefits. So that’s why we’re having this talk today. Yep. So I wanted to start because I first, when I, so when I had dental insurance a long time ago, I assumed it was like medical insurance.
Bonnie 00:03:46
Uh huh.
Dr. Mike 00:03:46
Which seems to be a common theme.
Bonnie 00:03:48
Yes, it is.
Dr. Mike 00:03:49
So can you touch on that a little bit? What is the difference?
Bonnie 00:03:53
So that’s a very little question.
Dr. Mike 00:03:56
Go on.
Bonnie 00:03:57
First and foremost, usually your medical has a deductible that you have to reach before they will cover anything. And you will see costs from 500 to 7000 just depending on your plan. And dental insurance is not even the reverse of that, but it is its own separate entity. Most plans cover anywhere between 1000 to like 3500 for your annual maximum. And your deductible tends to be fifty dollars to one hundred dollars. And so your dental insurance will only cover up to whatever your annual maximum is with of course, a bunch of caveats.
Dr. Mike 00:04:39
Asterisk, asterisk, asterisk, asterisk. So you’re saying if my dental insurance plan says 1500, they’re not going to pay 100% after I pay 1500?
Bonnie 00:04:49
No, they will pay $1,500 towards whatever you’re doing, depending on what you’re doing and what percentage they cover each procedure at.
Dr. Mike 00:05:00
Okay. So it’s essentially they’re, they’re basically telling me that is all we’ll pay.
Bonnie 00:05:04
Yes.
Dr. Mike 00:05:05
For the year, no matter if I need more.
Bonnie 00:05:07
Yes. And if you need more, your insurance won’t cover more just because you need more.
Dr. Mike 00:05:14
And then, okay, good to know.
Bonnie 00:05:16
Yes.
Dr. Mike 00:05:17
So then, okay, so that’s the major difference between medical and dental.
Bonnie 00:05:20
Yes.
Dr. Mike 00:05:21
So then in terms of annual maximums, what’s like an example? Like, I know that probably varies a lot, right?
Bonnie 00:05:27
Yeah. Our most common is anywhere between 1503 thousand 500, especially here in the Portland area. And I will say, though, that those numbers have not changed since about the 1980s. And so a lot of people are finding dental to be more and more expensive out of pocket. And it is because those annual maximums have not gone up with the times, whether it be inflation or just the fact that it’s been 30 plus years that they have not increased.
Dr. Mike 00:05:58
So, yeah, everything is pretty much costing two, three times. And it’s not just your supermarket. No, everything. Our supplies, our staff costs, it’s all gone up.
Bonnie 00:06:08
Gloves, masks, especially post pandemic, we have seen, oh, gosh, I don’t even know what the latest percentage is, but at a certain time, I know it was almost a hundred percent more just for gloves and masks in order for us to have them. Because, you know, as we work with people, we do have to change those out. And because there was such a huge shift in how we needed to make things, they shifted a lot of materials to masks specifically, and hospitals, of course, got it first, but the prices increased. And of course, just like your groceries have gone up, those prices have decreased a little bit, but they are going to remain that higher price forever.
Dr. Mike 00:06:54
Now, that’s what upsets me. I remember Bonnie and had this discussion and it was like the cost of chicken has gone up and it just doesn’t go back down.
Bonnie 00:07:01
No.
Dr. Mike 00:07:01
And that sucks.
Bonnie 00:07:03
Yeah. Shop locally if possible.
Dr. Mike 00:07:05
Shop local?
Bonnie 00:07:07
No, go get your chicken butchered at the farm and then buy it that way if you’re able to.
Dr. Mike 00:07:13
There you go. So, okay, so then with dental insurance, we have annual maximums that they’ll pay. So how do they determine what they’ll pay? Is it broken down into anything?
Bonnie 00:07:24
Yes, we end up having categories. So your insurance is three major categories. Preventative, basic and major preventative will be your exams, your x rays, your simple cleanings. Major would be like crowns and bridges, implants, dentures, things like that. And then basic would be just fillings. And usually it is. Basic is covered at 80, major is covered at 50, and then preventative is supposed to be covered at 100%. But as we see, quite often, those fees don’t match how much we charge. And so it’s more like about 90%, depending, again, on your coverage. Cause it’s really hard to talk about insurance because there are thousands of plans and they all handle them slightly differently.
Dr. Mike 00:08:19
And they’re all different, which is wild. Yes, it does upset me that I found out, well, I found this out from Bonnie recently, that if it says it’s 100% covered, it doesn’t mean it’s 100%, correct.
Bonnie 00:08:28
No, it doesn’t.
Dr. Mike 00:08:29
That is insane to me.
Bonnie 00:08:32
It is probably one of the harder things to talk to about with people, especially, we always encourage people to log on, find out their benefits, read every little piece of paper about it. So you understand your plan. Because, again, any office, especially like the office that I work at, we are a small office. There is no way for me to know thousands and thousands of plans. And they will do certain caps even though they, quote unquote, cover it to 100%. We see that very, very frequently. Especially, like, with something like a night guard. Night guards are expensive for the labs to make. It’s not cheap, it’s not free, and it’s not free. And insurance usually only covers, again, quote unquote, 100% up to, let’s say, $150. And so if the night guard is.
Dr. Mike 00:09:34
$400, I tell the patient it’s 100% covered. Because I, like, look quickly, it’s 100% covered, up to $150. That’s shady.
Bonnie 00:09:48
I’m like, if I had a nickel for every time that I just was flabbergasted by insurance and how they word things, I would have a bunch of nickels.
Dr. Mike 00:10:00
So it’s hard to understand.
Bonnie 00:10:02
So it is so hard to understand.
Dr. Mike 00:10:05
Bonnie gets a breakdown of your insurance. Like, she has to find it. It’s not like she just knows it. I do gets it all detailed. Right. So do patients have access to this? Like, can they look this up?
Bonnie 00:10:15
And again, I really recommend that everyone looks up their own insurance benefits. Usually you do have to create a login, but you should be able to see everything that I see and probably actually a little bit more.
Dr. Mike 00:10:29
It’s probably easier to get ahold of somebody.
Bonnie 00:10:31
Yes. And especially right now, post pandemic, it is near impossible to get ahold of people at insurance companies. We have seen a huge, huge increase of just. They hang up on you. You’ll be on. Yeah. Or it’s, you know, and AI can’t answer it, and so they just hang up on you.
Dr. Mike 00:10:54
I had that with Comcast.
Bonnie 00:10:56
Yeah.
Dr. Mike 00:10:56
The other day, I called. I call Comcast all the time. My Internet does not work.
Bonnie 00:10:59
Yeah.
Dr. Mike 00:11:00
And it was a. I bought, and then the bot was like, until you’ve tried the steps that I’ve said, yeah, I’m gonna end this call and end of the call.
Bonnie 00:11:07
Yeah. And they just hang up on.
Dr. Mike 00:11:08
And then you call. It says, call back if you need help.
Bonnie 00:11:10
Really? But I still need help. I don’t get a person.
Dr. Mike 00:11:12
And they’re like, you don’t get a person till you do this.
Bonnie 00:11:15
No. Yeah. It’s, it’s been very interesting to see the shift after, you know, post pandemic, but it’s also the life that we live now. And there’s a few things that I think is really important to know, especially because most people, when you have whatever career that you have and you have benefits, a part of it, dental does tend to change. Every January. Your company tends to decide where you go. And unfortunately, with that, there’s a few things that end up coming up. And probably the biggest thing that we see are like missing tooth clauses.
Dr. Mike 00:11:56
Oh, yeah. Where define that. Let’s go into that. That’s important.
Bonnie 00:12:00
So a missing tooth clause is if you are already missing that tooth and you start this new dental plan, they will not cover anything to go, quote unquote, on top of it. So they won’t cover, it’s called a pontic, if you get a bridge, and it’s that middle part that takes over the spot where your missing tooth was, they don’t cover that at all. They don’t cover implants. They don’t cover implant crowns. So even if it’s a covered benefit, partials that have. That you want to have a. Again, it’s called a pontic, but the fake tooth on a flipper, they will not cover it because it’s part of their missing tooth cloths. Which again, like we’re always talking about the asterisks of every plan, that it is very important to understand what those are in order to maximize your benefits.
Dr. Mike 00:12:52
Pre existing condition?
Bonnie 00:12:53
Yes, kind of, yes.
Dr. Mike 00:12:55
So they will. Even if I have a benefit plan that covers implants, like all these things, if this missing tooth clause is part of that, I will not get replacement.
Bonnie 00:13:05
Zero coverage on it.
Dr. Mike 00:13:06
Is there a timeline?
Bonnie 00:13:08
No, it’s just until you no longer have that plan that has that missing tooth cough.
Dr. Mike 00:13:12
That’s insane.
Bonnie 00:13:14
It is very frustrating.
Dr. Mike 00:13:16
What if you were born without the tooth?
Bonnie 00:13:18
Um, you know, it’s still the same. I think that you can appeal it if you have something that is like a genetic defect of some sort missing. I have seen success with that. That tends to be with children, though. So we’re talking about under 18, that they would cover something like that. Um, but you do have to prove it, right? And so a lot of times, you know, you move or whatever happens, or your old dentist is no longer around, and you had x rays taken when you were eight, and now you’re 17 and your bone’s ready for an implant, but you can’t prove that you’ve always had this missing. And if your plan has a missing tooth clause. They will deny it.
Dr. Mike 00:14:04
That is wild.
Bonnie 00:14:05
Yes. And what is also really hard with dental is we don’t have a central database where like, everyone’s records are. So, like when you go to Kaiser or peace, health or legacy, and if you’ve seen other specialists, they all have your records. Like, they can look at your medical chart and read anything that they need to about you. Right. We do not have that in dental. And so if it’s lost, it’s lost. And some older dentists will keep those records, but you are only required to keep them for seven years. So anything past seven years, you, I mean, you’re pushing a boulder up a hill.
Dr. Mike 00:14:50
I mean, especially if people were in paper charts.
Bonnie 00:14:52
Yes.
Dr. Mike 00:14:53
Like, how are you going to find that?
Bonnie 00:14:54
Yeah. And so, again, children tend to be a little bit more lenient, but anything proving as an adult is very, very hard. If you have that type of clause on your plan, which we see more and more missing tooth clauses, that’s wild. Waiting periods, age limits, sky’s the limit. On what?
Dr. Mike 00:15:17
So if I see in a plan that I’m like, oh, so and so has 100% coverage, I need to check for these little caveats.
Bonnie 00:15:22
Yes.
Dr. Mike 00:15:22
So what if I.
Bonnie 00:15:23
They’re buried. They’re buried.
Dr. Mike 00:15:24
So, through paper. I mean, you should see these PDF’s. It is so confusing.
Bonnie 00:15:29
Yeah.
Dr. Mike 00:15:29
Control find doesn’t even do it. So if I am starting a new job and I want to get dental insurance, I should kind of weigh these options then. Like, if I think I need a lot of work done or something, I should make sure my plan has certain coverages. Is that something I can see? That is what you’re saying, yeah.
Bonnie 00:15:44
And you should, as much as you can get as much information as you can for each. Like, if there’s different tiers that you can choose from and understanding which each tier has, because again, sometimes the higher tiers will have more clauses set to them and not always. Again, it’s really hard to say anything, you know, definitively, but that’s been probably, you know, people think they’re choosing a really great plan, but they’re actually not because it has something like that.
Dr. Mike 00:16:15
So check the coverage, then check the clauses.
Bonnie 00:16:18
Yes, absolutely.
Dr. Mike 00:16:18
And double check it.
Bonnie 00:16:19
And then double check it. And I always tell anyone that I’ve ever talked to on the phone, any questions, you have to call me back. And I will, as much as I can help them, even if, like, I know that they’re not going to be a patient here or they’re moving because I know that it is near impossible sometimes to find these answers or to understand what it means or to find someone to explain it to you. And so really good offices have front people that are always willing to do that for you, because we do understand out of the thousands of plans and.
Dr. Mike 00:16:59
Also some people questions to ask. Yeah, I would not. So if I called and I’m like, hey, do I have coverage for this? And Delta’s like, you have coverage for that? I don’t know. To ask if I have a missing tooth clause.
Bonnie 00:17:10
Yeah.
Dr. Mike 00:17:11
So, like, yeah, that’s.
Bonnie 00:17:13
I know, that’s insane. It’s rough, too. It’s been a very weird journey of understanding dental insurance because you can’t keep anything straight. What I know this year will be different than what I know next year, because all. Not all, but most insurance plans will change. And I will say that none of them have changed for the better. I have not seen them get better. I have seen them actually decrease what they cover. One of our major things that we’ve seen happen is annual limits used to not include any preventative. So your cleanings, x rays, exams with your doctor were not a part of that. And now we are seeing that it is a part of that. So anytime you go to the dentist for your cleaning, your x rays, and your exam, which should be, you know, twice a year for at least your cleanings, sometimes up to four, those are now being taken out of your annual limit. So you no longer, if you crack a tooth. Cause you eat almonds or, you know, whatever happens, you’re hiking, you’re biking, you’re rock climbing. All the things that people wonder. Where she lives in the Pacific Northwest. Do you end up burning through so much of your benefits just through doing your preventative, which is what you’re supposed to do, you know, just like you’re supposed to go to the doctor and get certain things done at certain timelines. Dentistry, you are supposed to get your teeth cleaned every six months and see your doctor a minimum of once a year and have your x rays every year. That’s how we get early.
Dr. Mike 00:18:50
I was telling someone the other day, like, I appreciate yearly x rays. One. Because now dental x rays, the dose is so low, like, radiation is almost negligible.
Bonnie 00:19:00
Right.
Dr. Mike 00:19:00
But also, if we catch something, it’s a banana. Yeah. It’s like eating a banana, which is wild, but it’s like, the most predictable treatment we can give you is when it’s caught early.
Bonnie 00:19:10
Yes, absolutely.
Dr. Mike 00:19:10
Just like anything in medicine. If we see a small cavity on the x ray, I’m happy because then we’ve caught it. It’s more predictable. But if we wait and wait and wait, God knows what it’s going to be.
Bonnie 00:19:20
Yeah. And, you know, again, having been in dentistry for about ten years now, it never ceases to amaze me how much we end up do. See, you know, we have so many people that for whatever reasons, they weren’t able to go to the dentist for even like, three years and how much things can grow and, I mean, dealing with, I guess, disappointment, maybe even in themselves, of, like, I let this go for so long, and now it’s. I mean, it. It’s a higher, higher cost every single time.
Dr. Mike 00:19:55
Yep. The more work that has to be.
Bonnie 00:19:57
Done, the more it costs and just.
Dr. Mike 00:19:59
You know, save for any profession.
Bonnie 00:20:00
Right. And decay does its thing. It doesn’t parties and it gets bigger. It does party in your mouth. Absolutely.
Dr. Mike 00:20:08
Well, Bonnie, this has been lovely.
Bonnie 00:20:10
Yeah.
Dr. Mike 00:20:10
Any more final words?
Bonnie 00:20:12
Oh, jeez.
Dr. Mike 00:20:12
People need, almost need to probably make a part two because there’s a lot we have not covered.
Bonnie 00:20:16
But, yeah, it is really hard because, again, it does always change. But just being aware of what your benefits are, what your limits are, and what you can actually expect your insurance to cover is very. I think it just, everyone needs to know exactly what it is. And then I do think that will actually help lead some change if people start actually not fighting back. But speaking up about dental coverage, coverage here in the United States, we often get blamed. Yes.
Dr. Mike 00:20:55
Even though it’s not us that’s doing the dictating in terms of coverage. But it’s important that people like you that have dental insurance complain like, hey, this should be covered, or, why is this denied? Or things like that. So I think that maybe there needs to be more involvement in patients with their dental insurance.
Bonnie 00:21:11
Absolutely. And again, most of the time, it’s just, you know, most of the time, it’s an app on your phone, if we’re being real. But, you know, getting that breakdown from your employer and getting that breakdown from your actual insurance company. And again, any questions that you have, I’m not the only one that is willing to answer any questions. Most people I know that work upfront, especially as financial or treatment advice coordinators, we will always be willing to talk to people to make sure that they’re maximizing everything that they can do.
Dr. Mike 00:21:42
They know it all.
Bonnie 00:21:43
Yeah. All of it.
Dr. Mike 00:21:45
Everything. Well, Bonnie, this has been great. Yeah, absolutely.
Bonnie 00:21:48
Yeah. Thanks for having me.
Dr. Mike 00:21:49
Of course.
Bonnie 00:21:50
Good, good.
Dr. Mike 00:21:51
She’ll be back. Don’t worry.
Bonnie 00:21:52
Always.
Dr. Mike 00:21:53
All right, everybody have a good night. Thanks for tuning in. Bye.
Bonnie 00:21:56
Thank you.
Ashley 00:21:59
Thank you for listening to today’s episode of DM a Dentist, brought to you by dose of dental. And thank you for your interest in improving your oral health. If you’d like your questions answered by Doctor Rusty and Doctor Mike, visit us at http://www.doseofdental.com or dm us on instagram at yourdailydose of dental.
View all episodes
By Dose of DentalLast week we talked about the various positions that make up a dental office. There were quite a few followup questions asking us to expand on some of the job descriptions. So, we decided to start a series of “who’s who in the dental office”. This will be a 3 part series and we are starting off strong with the business team. This week Bonnie Kost is joining us and talking about all things related to dental insurance. She explains the difference between medical insurance and dental insurance, dives into some insurance nuances to look out for when choosing a dental plan, and gives you some tips to help you maximize your benefits. You don’t want to miss this episode!
As always, feel free to reach out through our instagram @YourDailyDoseOfDental or through our website http://www.DoseOfDental.com. We would love to hear from you and hope your questions can be featured on our show!
Instagram: https://www.instagram.com/yourdailydoseofdental/
Website: https://doseofdental.com/
TikTok: https://www.tiktok.com/@dmadentist
Ashley 00:00:02
Welcome to DM, a dentist, your friendly neighborhood podcast, where doctor Rusty and doctor Mike are here to make dental care approachable for everyone because everyone deserves a healthy smile without the fear.
Dr. Mike 00:00:24
Alrighty, so I have Bonnie with us today. Say hello, Bonnie.
Bonnie 00:00:28
Hello. Well, hello, everyone.
Dr. Mike 00:00:29
This is Bonnie. She’s been working in dental for how long now?
Bonnie 00:00:33
About ten years now. I started in the back.
Dr. Mike 00:00:36
Start in the back.
Bonnie 00:00:37
We talked about that last week.
Dr. Mike 00:00:38
So what is back?
Bonnie 00:00:40
Back office is being a dental assistant, being a hygienist, being a dentist. So front office does everything up front. So we push the paper and do all of the insurance and scheduling, and back does everything else for us.
Dr. Mike 00:00:58
So, yeah. Like clinical versus business team.
Bonnie 00:01:01
Yes, absolutely.
Dr. Mike 00:01:02
So, yeah, Bonnie’s been doing this for a while, so we had her on the show. I know we talked about last week, what are the different roles in the dental office? And this week we decided, why not talk to someone who does it for a living?
Bonnie 00:01:13
I do do it for a living. I am technically a finance coordinator, which is a fancy way of saying, I tell you how much everything’s gonna cost.
Dr. Mike 00:01:22
So you would say you are well versed in the insurances, eh?
Bonnie 00:01:27
I have so much knowledge of insurance that sometimes it hurts. There are thousands of different plans out there, and our goal is always to know as much as we possibly can in order for our patients to get the most out of their benefits.
Dr. Mike 00:01:43
And it’s hard. Cause it’s always. You were saying earlier, it’s always a moving scale, right?
Bonnie 00:01:47
Yes. Sometimes it does feel like we’re on a little bit of quicksand. Like, say anything is an absolute, and it changes every January. So every January, we have a big push to rediscover every dental plan that we have coming into our offices.
Dr. Mike 00:02:09
That’s wild. So they change a lot.
Bonnie 00:02:10
They change quite a bit, actually. And I will call it frustrating, but it’s also, you know, that is just how our country is ran with dental insurance currently.
Dr. Mike 00:02:23
And the bad thing is I will do things in the back and, like, treatment plan all these things and get all excited, and then I’m like, oh, it’s probably covered. Who knows?
Bonnie 00:02:32
And it’s not.
Dr. Mike 00:02:34
So I’m the one that gets Bonnie in trouble, but he does quite a bit. Hey, we’re very good friends, so I’m allowed to do that.
Bonnie 00:02:39
Yes, absolutely.
Dr. Mike 00:02:41
Okay, Bonnie, let’s dive in. So the one thing that gets me into hot water as the dentist is I don’t know much about dental insurance. That’s why Bonnie’s here.
Bonnie 00:02:48
Yep.
Dr. Mike 00:02:49
And I think it’s good. I don’t like, I’m here to give the clinical side of things not necessarily be dictated by corporate America.
Bonnie 00:02:56
Thank you. Yep. And I do, I do actually prefer it that way. When I am looking for an office to work at, I, while it’s nice for the doctor to acknowledge costs of things, I think their job is to plan the best smile for you and whatever that looks like. And we can always come up with alternatives, but the dentist should not be even considering cost because it changes how they do things. And we want what’s best for each person that comes into our offices.
Dr. Mike 00:03:29
Right. We want what’s best for you. So we’re not going to be driven by insurance.
Bonnie 00:03:33
Exactly.
Dr. Mike 00:03:33
We want you to maximize your benefits. So that’s why we’re having this talk today. Yep. So I wanted to start because I first, when I, so when I had dental insurance a long time ago, I assumed it was like medical insurance.
Bonnie 00:03:46
Uh huh.
Dr. Mike 00:03:46
Which seems to be a common theme.
Bonnie 00:03:48
Yes, it is.
Dr. Mike 00:03:49
So can you touch on that a little bit? What is the difference?
Bonnie 00:03:53
So that’s a very little question.
Dr. Mike 00:03:56
Go on.
Bonnie 00:03:57
First and foremost, usually your medical has a deductible that you have to reach before they will cover anything. And you will see costs from 500 to 7000 just depending on your plan. And dental insurance is not even the reverse of that, but it is its own separate entity. Most plans cover anywhere between 1000 to like 3500 for your annual maximum. And your deductible tends to be fifty dollars to one hundred dollars. And so your dental insurance will only cover up to whatever your annual maximum is with of course, a bunch of caveats.
Dr. Mike 00:04:39
Asterisk, asterisk, asterisk, asterisk. So you’re saying if my dental insurance plan says 1500, they’re not going to pay 100% after I pay 1500?
Bonnie 00:04:49
No, they will pay $1,500 towards whatever you’re doing, depending on what you’re doing and what percentage they cover each procedure at.
Dr. Mike 00:05:00
Okay. So it’s essentially they’re, they’re basically telling me that is all we’ll pay.
Bonnie 00:05:04
Yes.
Dr. Mike 00:05:05
For the year, no matter if I need more.
Bonnie 00:05:07
Yes. And if you need more, your insurance won’t cover more just because you need more.
Dr. Mike 00:05:14
And then, okay, good to know.
Bonnie 00:05:16
Yes.
Dr. Mike 00:05:17
So then, okay, so that’s the major difference between medical and dental.
Bonnie 00:05:20
Yes.
Dr. Mike 00:05:21
So then in terms of annual maximums, what’s like an example? Like, I know that probably varies a lot, right?
Bonnie 00:05:27
Yeah. Our most common is anywhere between 1503 thousand 500, especially here in the Portland area. And I will say, though, that those numbers have not changed since about the 1980s. And so a lot of people are finding dental to be more and more expensive out of pocket. And it is because those annual maximums have not gone up with the times, whether it be inflation or just the fact that it’s been 30 plus years that they have not increased.
Dr. Mike 00:05:58
So, yeah, everything is pretty much costing two, three times. And it’s not just your supermarket. No, everything. Our supplies, our staff costs, it’s all gone up.
Bonnie 00:06:08
Gloves, masks, especially post pandemic, we have seen, oh, gosh, I don’t even know what the latest percentage is, but at a certain time, I know it was almost a hundred percent more just for gloves and masks in order for us to have them. Because, you know, as we work with people, we do have to change those out. And because there was such a huge shift in how we needed to make things, they shifted a lot of materials to masks specifically, and hospitals, of course, got it first, but the prices increased. And of course, just like your groceries have gone up, those prices have decreased a little bit, but they are going to remain that higher price forever.
Dr. Mike 00:06:54
Now, that’s what upsets me. I remember Bonnie and had this discussion and it was like the cost of chicken has gone up and it just doesn’t go back down.
Bonnie 00:07:01
No.
Dr. Mike 00:07:01
And that sucks.
Bonnie 00:07:03
Yeah. Shop locally if possible.
Dr. Mike 00:07:05
Shop local?
Bonnie 00:07:07
No, go get your chicken butchered at the farm and then buy it that way if you’re able to.
Dr. Mike 00:07:13
There you go. So, okay, so then with dental insurance, we have annual maximums that they’ll pay. So how do they determine what they’ll pay? Is it broken down into anything?
Bonnie 00:07:24
Yes, we end up having categories. So your insurance is three major categories. Preventative, basic and major preventative will be your exams, your x rays, your simple cleanings. Major would be like crowns and bridges, implants, dentures, things like that. And then basic would be just fillings. And usually it is. Basic is covered at 80, major is covered at 50, and then preventative is supposed to be covered at 100%. But as we see, quite often, those fees don’t match how much we charge. And so it’s more like about 90%, depending, again, on your coverage. Cause it’s really hard to talk about insurance because there are thousands of plans and they all handle them slightly differently.
Dr. Mike 00:08:19
And they’re all different, which is wild. Yes, it does upset me that I found out, well, I found this out from Bonnie recently, that if it says it’s 100% covered, it doesn’t mean it’s 100%, correct.
Bonnie 00:08:28
No, it doesn’t.
Dr. Mike 00:08:29
That is insane to me.
Bonnie 00:08:32
It is probably one of the harder things to talk to about with people, especially, we always encourage people to log on, find out their benefits, read every little piece of paper about it. So you understand your plan. Because, again, any office, especially like the office that I work at, we are a small office. There is no way for me to know thousands and thousands of plans. And they will do certain caps even though they, quote unquote, cover it to 100%. We see that very, very frequently. Especially, like, with something like a night guard. Night guards are expensive for the labs to make. It’s not cheap, it’s not free, and it’s not free. And insurance usually only covers, again, quote unquote, 100% up to, let’s say, $150. And so if the night guard is.
Dr. Mike 00:09:34
$400, I tell the patient it’s 100% covered. Because I, like, look quickly, it’s 100% covered, up to $150. That’s shady.
Bonnie 00:09:48
I’m like, if I had a nickel for every time that I just was flabbergasted by insurance and how they word things, I would have a bunch of nickels.
Dr. Mike 00:10:00
So it’s hard to understand.
Bonnie 00:10:02
So it is so hard to understand.
Dr. Mike 00:10:05
Bonnie gets a breakdown of your insurance. Like, she has to find it. It’s not like she just knows it. I do gets it all detailed. Right. So do patients have access to this? Like, can they look this up?
Bonnie 00:10:15
And again, I really recommend that everyone looks up their own insurance benefits. Usually you do have to create a login, but you should be able to see everything that I see and probably actually a little bit more.
Dr. Mike 00:10:29
It’s probably easier to get ahold of somebody.
Bonnie 00:10:31
Yes. And especially right now, post pandemic, it is near impossible to get ahold of people at insurance companies. We have seen a huge, huge increase of just. They hang up on you. You’ll be on. Yeah. Or it’s, you know, and AI can’t answer it, and so they just hang up on you.
Dr. Mike 00:10:54
I had that with Comcast.
Bonnie 00:10:56
Yeah.
Dr. Mike 00:10:56
The other day, I called. I call Comcast all the time. My Internet does not work.
Bonnie 00:10:59
Yeah.
Dr. Mike 00:11:00
And it was a. I bought, and then the bot was like, until you’ve tried the steps that I’ve said, yeah, I’m gonna end this call and end of the call.
Bonnie 00:11:07
Yeah. And they just hang up on.
Dr. Mike 00:11:08
And then you call. It says, call back if you need help.
Bonnie 00:11:10
Really? But I still need help. I don’t get a person.
Dr. Mike 00:11:12
And they’re like, you don’t get a person till you do this.
Bonnie 00:11:15
No. Yeah. It’s, it’s been very interesting to see the shift after, you know, post pandemic, but it’s also the life that we live now. And there’s a few things that I think is really important to know, especially because most people, when you have whatever career that you have and you have benefits, a part of it, dental does tend to change. Every January. Your company tends to decide where you go. And unfortunately, with that, there’s a few things that end up coming up. And probably the biggest thing that we see are like missing tooth clauses.
Dr. Mike 00:11:56
Oh, yeah. Where define that. Let’s go into that. That’s important.
Bonnie 00:12:00
So a missing tooth clause is if you are already missing that tooth and you start this new dental plan, they will not cover anything to go, quote unquote, on top of it. So they won’t cover, it’s called a pontic, if you get a bridge, and it’s that middle part that takes over the spot where your missing tooth was, they don’t cover that at all. They don’t cover implants. They don’t cover implant crowns. So even if it’s a covered benefit, partials that have. That you want to have a. Again, it’s called a pontic, but the fake tooth on a flipper, they will not cover it because it’s part of their missing tooth cloths. Which again, like we’re always talking about the asterisks of every plan, that it is very important to understand what those are in order to maximize your benefits.
Dr. Mike 00:12:52
Pre existing condition?
Bonnie 00:12:53
Yes, kind of, yes.
Dr. Mike 00:12:55
So they will. Even if I have a benefit plan that covers implants, like all these things, if this missing tooth clause is part of that, I will not get replacement.
Bonnie 00:13:05
Zero coverage on it.
Dr. Mike 00:13:06
Is there a timeline?
Bonnie 00:13:08
No, it’s just until you no longer have that plan that has that missing tooth cough.
Dr. Mike 00:13:12
That’s insane.
Bonnie 00:13:14
It is very frustrating.
Dr. Mike 00:13:16
What if you were born without the tooth?
Bonnie 00:13:18
Um, you know, it’s still the same. I think that you can appeal it if you have something that is like a genetic defect of some sort missing. I have seen success with that. That tends to be with children, though. So we’re talking about under 18, that they would cover something like that. Um, but you do have to prove it, right? And so a lot of times, you know, you move or whatever happens, or your old dentist is no longer around, and you had x rays taken when you were eight, and now you’re 17 and your bone’s ready for an implant, but you can’t prove that you’ve always had this missing. And if your plan has a missing tooth clause. They will deny it.
Dr. Mike 00:14:04
That is wild.
Bonnie 00:14:05
Yes. And what is also really hard with dental is we don’t have a central database where like, everyone’s records are. So, like when you go to Kaiser or peace, health or legacy, and if you’ve seen other specialists, they all have your records. Like, they can look at your medical chart and read anything that they need to about you. Right. We do not have that in dental. And so if it’s lost, it’s lost. And some older dentists will keep those records, but you are only required to keep them for seven years. So anything past seven years, you, I mean, you’re pushing a boulder up a hill.
Dr. Mike 00:14:50
I mean, especially if people were in paper charts.
Bonnie 00:14:52
Yes.
Dr. Mike 00:14:53
Like, how are you going to find that?
Bonnie 00:14:54
Yeah. And so, again, children tend to be a little bit more lenient, but anything proving as an adult is very, very hard. If you have that type of clause on your plan, which we see more and more missing tooth clauses, that’s wild. Waiting periods, age limits, sky’s the limit. On what?
Dr. Mike 00:15:17
So if I see in a plan that I’m like, oh, so and so has 100% coverage, I need to check for these little caveats.
Bonnie 00:15:22
Yes.
Dr. Mike 00:15:22
So what if I.
Bonnie 00:15:23
They’re buried. They’re buried.
Dr. Mike 00:15:24
So, through paper. I mean, you should see these PDF’s. It is so confusing.
Bonnie 00:15:29
Yeah.
Dr. Mike 00:15:29
Control find doesn’t even do it. So if I am starting a new job and I want to get dental insurance, I should kind of weigh these options then. Like, if I think I need a lot of work done or something, I should make sure my plan has certain coverages. Is that something I can see? That is what you’re saying, yeah.
Bonnie 00:15:44
And you should, as much as you can get as much information as you can for each. Like, if there’s different tiers that you can choose from and understanding which each tier has, because again, sometimes the higher tiers will have more clauses set to them and not always. Again, it’s really hard to say anything, you know, definitively, but that’s been probably, you know, people think they’re choosing a really great plan, but they’re actually not because it has something like that.
Dr. Mike 00:16:15
So check the coverage, then check the clauses.
Bonnie 00:16:18
Yes, absolutely.
Dr. Mike 00:16:18
And double check it.
Bonnie 00:16:19
And then double check it. And I always tell anyone that I’ve ever talked to on the phone, any questions, you have to call me back. And I will, as much as I can help them, even if, like, I know that they’re not going to be a patient here or they’re moving because I know that it is near impossible sometimes to find these answers or to understand what it means or to find someone to explain it to you. And so really good offices have front people that are always willing to do that for you, because we do understand out of the thousands of plans and.
Dr. Mike 00:16:59
Also some people questions to ask. Yeah, I would not. So if I called and I’m like, hey, do I have coverage for this? And Delta’s like, you have coverage for that? I don’t know. To ask if I have a missing tooth clause.
Bonnie 00:17:10
Yeah.
Dr. Mike 00:17:11
So, like, yeah, that’s.
Bonnie 00:17:13
I know, that’s insane. It’s rough, too. It’s been a very weird journey of understanding dental insurance because you can’t keep anything straight. What I know this year will be different than what I know next year, because all. Not all, but most insurance plans will change. And I will say that none of them have changed for the better. I have not seen them get better. I have seen them actually decrease what they cover. One of our major things that we’ve seen happen is annual limits used to not include any preventative. So your cleanings, x rays, exams with your doctor were not a part of that. And now we are seeing that it is a part of that. So anytime you go to the dentist for your cleaning, your x rays, and your exam, which should be, you know, twice a year for at least your cleanings, sometimes up to four, those are now being taken out of your annual limit. So you no longer, if you crack a tooth. Cause you eat almonds or, you know, whatever happens, you’re hiking, you’re biking, you’re rock climbing. All the things that people wonder. Where she lives in the Pacific Northwest. Do you end up burning through so much of your benefits just through doing your preventative, which is what you’re supposed to do, you know, just like you’re supposed to go to the doctor and get certain things done at certain timelines. Dentistry, you are supposed to get your teeth cleaned every six months and see your doctor a minimum of once a year and have your x rays every year. That’s how we get early.
Dr. Mike 00:18:50
I was telling someone the other day, like, I appreciate yearly x rays. One. Because now dental x rays, the dose is so low, like, radiation is almost negligible.
Bonnie 00:19:00
Right.
Dr. Mike 00:19:00
But also, if we catch something, it’s a banana. Yeah. It’s like eating a banana, which is wild, but it’s like, the most predictable treatment we can give you is when it’s caught early.
Bonnie 00:19:10
Yes, absolutely.
Dr. Mike 00:19:10
Just like anything in medicine. If we see a small cavity on the x ray, I’m happy because then we’ve caught it. It’s more predictable. But if we wait and wait and wait, God knows what it’s going to be.
Bonnie 00:19:20
Yeah. And, you know, again, having been in dentistry for about ten years now, it never ceases to amaze me how much we end up do. See, you know, we have so many people that for whatever reasons, they weren’t able to go to the dentist for even like, three years and how much things can grow and, I mean, dealing with, I guess, disappointment, maybe even in themselves, of, like, I let this go for so long, and now it’s. I mean, it. It’s a higher, higher cost every single time.
Dr. Mike 00:19:55
Yep. The more work that has to be.
Bonnie 00:19:57
Done, the more it costs and just.
Dr. Mike 00:19:59
You know, save for any profession.
Bonnie 00:20:00
Right. And decay does its thing. It doesn’t parties and it gets bigger. It does party in your mouth. Absolutely.
Dr. Mike 00:20:08
Well, Bonnie, this has been lovely.
Bonnie 00:20:10
Yeah.
Dr. Mike 00:20:10
Any more final words?
Bonnie 00:20:12
Oh, jeez.
Dr. Mike 00:20:12
People need, almost need to probably make a part two because there’s a lot we have not covered.
Bonnie 00:20:16
But, yeah, it is really hard because, again, it does always change. But just being aware of what your benefits are, what your limits are, and what you can actually expect your insurance to cover is very. I think it just, everyone needs to know exactly what it is. And then I do think that will actually help lead some change if people start actually not fighting back. But speaking up about dental coverage, coverage here in the United States, we often get blamed. Yes.
Dr. Mike 00:20:55
Even though it’s not us that’s doing the dictating in terms of coverage. But it’s important that people like you that have dental insurance complain like, hey, this should be covered, or, why is this denied? Or things like that. So I think that maybe there needs to be more involvement in patients with their dental insurance.
Bonnie 00:21:11
Absolutely. And again, most of the time, it’s just, you know, most of the time, it’s an app on your phone, if we’re being real. But, you know, getting that breakdown from your employer and getting that breakdown from your actual insurance company. And again, any questions that you have, I’m not the only one that is willing to answer any questions. Most people I know that work upfront, especially as financial or treatment advice coordinators, we will always be willing to talk to people to make sure that they’re maximizing everything that they can do.
Dr. Mike 00:21:42
They know it all.
Bonnie 00:21:43
Yeah. All of it.
Dr. Mike 00:21:45
Everything. Well, Bonnie, this has been great. Yeah, absolutely.
Bonnie 00:21:48
Yeah. Thanks for having me.
Dr. Mike 00:21:49
Of course.
Bonnie 00:21:50
Good, good.
Dr. Mike 00:21:51
She’ll be back. Don’t worry.
Bonnie 00:21:52
Always.
Dr. Mike 00:21:53
All right, everybody have a good night. Thanks for tuning in. Bye.
Bonnie 00:21:56
Thank you.
Ashley 00:21:59
Thank you for listening to today’s episode of DM a Dentist, brought to you by dose of dental. And thank you for your interest in improving your oral health. If you’d like your questions answered by Doctor Rusty and Doctor Mike, visit us at http://www.doseofdental.com or dm us on instagram at yourdailydose of dental.