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Maximizing your Dental Insurance – Dr. Matiasevich – Santa Cruz Dentist

Maximizing your dental insurance

Doctor: It’s a little bit different than medical insurance. The way dental insurance works is an employer will buy a plan, essentially will shop for a plan, that will work for his employees, and he’ll purchase that plan. But there’s hundreds of plans even within different insurance companies, and each one of those plans is tailored to what the employer picks and chooses to be in the plan.

An example would be, let’s say, an employer purchases a plan as a lot of coverage for diagnostic services. That’s like coming in having your teeth checked, X-rays, cleaning, and maybe to do some fillings, but the plan doesn’t cover a crown, which is excluded from the planners. No coverage for crowns. So that patient, then, if they come in and they break a tooth and the only treatment…or the only solution is a crown, it’s not going to be covered by their plan because of what the employer purchased. So it’s not that it’s not indicated, it’s just it’s not covered by their plan.

The other thing with medicals, medical generally has a really high deductible, or not…I actually shouldn’t say high deductible but has a very high maximum, sometimes in the millions of dollars in case you get really injured and you’re in the hospital for months at a time.

Dentistry still gives the same maximum that it did 34 years ago, which is a 1,000 to $2,000 per year, and you have to use that money within that year or you lose it and starts over again. The problem with that, is that was great back in the late ’60s, early ’70s, but hasn’t kept pace with inflation and now that thousand dollars doesn’t go very far, whereas medical insurance, you just…it pays 70% or 80% of a procedure and keeps going up to million dollars where dental insurance is just based on a calendar. So it is a lot different.

One of the things with all the training that I have now, is that I am able to apply a lot of different avenues towards a patients’ problems. So yes, I can find something that has a solution for what a person is seeking. A lot of patients will come in and they’ll say, “Well, I went to dentist X, Y, and Z, and they all told me I was going to lose all my teeth and then I need to have dentures. And, you know, my mom wear dentures, my dad wear dentures. They hated them and the last thing I want to do is wear dentures. Is there anything else you can do for me?”

And, “Yeah,” And there is a lot of things we can do nowadays. I had a patient once that came in that this was five, six years ago. She was actually a younger patient, Maria. She was about 30, 35 years-old. She was trying to get pregnant and the dentist had told her, basically, she was going to lose all of her teeth because she hadn’t been in a while. And she came in and she was just crying about it because she’d only been married for five, six years and now she was being told that she’s going to lose all her teeth, and she just didn’t want to have that happen.

And we were able to develop a treatment plan where she only lost a couple teeth. We were able to replace them. She was never without her teeth, and to this day she still has them. So that was really exciting. And heard she actually…she gives a really nice testimonial on our website about that but she’s a really cute lady, and it’s just you get a lot of joy and satisfaction from that. But yeah, we’ve had…there’s a lot of avenues.

I think one of the problems with general dentistry today is a lot of dentist will get confined to what they were trained in dental school, and don’t go on and learn something new. Because the a profession is changing, I mean, just around us today, technology is changing, but that’s also driving science in what we do. And those some technologies can be applied to people, and people don’t necessarily have to have some sort of technology like a denture that maybe is 200, 300 years old, that they associate with George Washington, where nowadays, they can have something better and we can rebuild what’s missing.

So one of the things that we do for everybody in our office, is we do a complimentary benefit’s check when they first come in. And the reason we do that is so that they know their coverage upfront so there’s no surprises later. And then the other thing that we will do, is will process their insurance, and help them maximize it, and try and give them direction because generally every year, there’s a thing called open enrollment where a patient is able to go back, talk to their employer or their HR Department, and be able to change their plans so that maybe next year they would have coverage for another procedure.

But usually, the idea that the insurance company is rejecting something isn’t because it’s not needed or not indicated, it’s because it’s not covered by the plan.