The Myth of Insurance

The Myth of Insurance, Part II

So, we’ve touched on how insurance started. It actually started in California back in the 1950’s. It was a way for the workers to get some compensation for the work that they were doing. It did become more main stream in the 1970’s, where employers were offering $1000 per year benefit. Now, doing the reverse math on this, a $12000 crown today would have cost you $362 back in 1971. Back then, it was a similar structure to what it is now, 100% of preventative (exams, x-rays and regular cleanings), 80% of basic (fillings, and most insurances consider basic to be periodontal or gum disease cleanings, root canals and extractions) and 50% of major (most insurances consider crowns or caps major, bridges, partials, dentures and implants). So, 50% of a $362 crown is $181.

Yes, my math is correct. Back in 1971, with your $1000 maximum, you would have used almost 20% of your insurance for ONE crown. You could have about 5 crowns for the price of one crown in 2016, yet your insurance dictates that you only get one crown a year. How in the heck are you supposed to keep your overall heath if you’re keeping your budge to whatever your insurance covers? The answer is, you’re not! You’re going to spend 5-10 years fixing the “infection” in your mouth at these rates, and that doesn’t include future work, so if the infection spreads (and we guarantee it will spread), you’re are, for lack of a better phrase, shit out of luck.

This is where dentistry gets its “it’s too expensive” name. Dental insurance hasn’t kept up its maximum with inflation. Health insurance has barely kept up, but dental insurance is still back in the 1970’s and 1980’s prices. I can tell you from the dental side of insurance, even their fees that they pay haven’t gotten any better. They have actually gotten 10x worse. I am looking at the future of dentistry thinking that there might not be much of a future. I am hoping there is, both for Bischoff Family Dentistry’s sake and my sake. I know A LOT about dentistry and hope to make it my future. But, if insurances have their way, it might not be much of a future.

Ten years ago, we as a dental office were getting paid $5-600 per crown if not more. Now a days, if you are in network, you are lucky to get $7-800 per crown. I know on the Delta “premier” plans, you can get almost $1000 if you are an in network doctor, but if it is a Delta PPO plan, then you’re getting between $500-800 per crown allowance from Delta. Which means it’s $250-$400 per crown that Delta Dental is paying you, and requiring you collect from your patient the other half of the $250-$400 per crown. Between the lab fees (which vary from lab to lab, but the top quality labs are $200 per crown made) and overhead, the dentist isn’t making any money on a crown.

That’s where the “crowns from China” have become popular. You pay $50 per crown, it may fit, it may not fit. It may be good quality materials, or it may have tons of lead and mercury in it crowns. This is why a lot of doctors have to swear to their liability insurances that their crowns aren’t shipped to China. It’s just a lot of money to make one crown and not be compensated enough to cover the cost of that crown.