A recurring challenge in the dental office is addressing patients’ expectations of their dental insurance benefits.
In Canada, and our province of Ontario, the vast majority of residents enjoy the benefits of universal healthcare. Universal healthcare was established through various acts of legislation within Canada and by individual provinces. 1966 is the generally accepted start date of federally mandated universal healthcare.
The glaring omission from universal healthcare was, and continues to be, dental healthcare.
The reasons for this omission included the belief that oral disease was largely preventable by the individual, and that community treatments such as water fluoridation would be sufficient.
Employee benefit plans also started in and around the 1960s. Most employers purchase a plan from an insurance company with benefits that usually include some dental coverage. Plan maximums have rarely increased, yet premiums have gone up significantly since then. Many plans still limit coverage to $1000 per year.
In 1960, $1000 went a long way for dental care. Today, that maximum should be $8490 if it kept up with inflation.
Dental coverage is very limited by a number of factors including
annual maximums
co-payment requirements
deductibles
frequency limitations
repayment schedules that do not cover full cost of service
little or nor coverage for major work such as dentures, crowns, bridges, implants, etc.
The above limitations are all cost-containment measures to maximize dental insurance profitability.
Today’s dental plans are not intended to cover advanced procedures or major oral health rehabilitation. If you are lucky, your plan may include partial coverage for 1 crown or bridge, subject to all sorts of conditions and limitations.
Most often, plans cover routine dental cleanings, basic fillings, and extractions.
Quite often, I see patients who have, through a number of circumstances (poor professional advice, limited finances, or other pressing demands), neglected their oral health and now need help that exceeds the scope of their dental plans.