The Shocking Truth About Dental Insurance In Southwest Florida - All About Dental, Pet, Health and Motorcycle Insurance

The Shocking Truth About Dental Insurance In Southwest Florida

Meta Description: Southwest Florida consumers have dropped subscriptions from dental insurance companies. This article will explain the unbelievable reason for the incident.

Introduction

Everyone wants to contribute what they can in doing their job, no matter what their profession is. They could be working in different areas, from education, construction, medical care to arts and crafts.

Unfortunately, despite the positive thinking and attitude that most people try to maintain, corruptions are bound to happen. And recently, the incident with dental insurance companies in Southwest Florida has been brought to the public attention.

The event involves a large number of consumers terminating their insurance contracts. This is the consequence of the companies’ method of making profits by misleading the consumers and reduce or avoid the coverage completely.

This article will describe the details of the unbelievable truth behind dental insurance companies.

What's behind the dental insurance companies?

What Dental Insurance Plans Cover

To clarify consumers’ misunderstandings due to the insurance company consultants not providing enough necessary information, here’s a breakdown on what dental insurance plans actually cover.

Normally, a plan has the coverage with the 100/80/50 ratio. The percentage depends on the type of treatment:

Routine Care

Also known as preventive care. This is commonly known as the regular checkup procedure. It includes the exams, cleanings, and X-rays. The patient can schedule checkups with the dentist. The total procedure is covered with the 100 percent rate.

Complex Dental

Fillings for cavities, tooth extractions, and oral surgery are what classified as complex dental. The dental insurance plan will cover from 70 to 80 percent.

The coverage rate depends on the type of treatment 


Major Dental

Major dental includes procedures like crowns, root canals, dentures, bridges, or implants. These cases can require the patient to have multi-stage treatment to ensure that the dentists follow the patient’s symptoms closely. The dental insurance company will pay about 50 percent or less.

Other procedures like cosmetic dental, for example, teeth whitening is not considered as a treatment that the insurance can cover. Consumers will have to pay extra expenses by themselves.

Why Subscribers Are Withdrawing From The Dental Insurance Plans

Now, let’s dive into the most anticipated part of this article.

Southwest Floridians have claimed that dental insurance companies deny the consumers benefits and create situations where they have to pay for the services with their own budget.
In fact, this is not a false claim.

Dental insurance companies use methods to avoid payments

Dr. Kelly Blodgett shared his experience in an article from Blodgett Dental Care official website.

As a dentist who dedicates his career to make good use of what he had learned in the medical education, Dr. Blodgett can’t withstand the fact that insurance companies literally rob people of their hard-earned investment.

He reveals that dental insurance companies maximize their profit, but avoid violating the law with a simple method: delay the payment.

The story that Dr. Blodgett had witnessed could happen to anyone who works with the insurance carrier. His patient had done the gum rejuvenation technique, which is clearly included in the insurance plans.

After the work is done, Dr. Blodgett’s staff member sent the documents to the company to explain the treatment and request the payment. But then the company replied that they don’t have enough information to clarify that the patient had the exact services as mentioned in the files.

What’s more shocking is that the company’s consultant never made any contact with the patient. The troubles just continue with Dr. Blodgett’s staff member sending more details, and the company kept denying the payment.

And then on the day Dr. Blodgett was supposed to meet with the insurance company expert, the office staff received a phone call from the company, claiming that the payment is in process. This happened after 8 months of the documents being in denial.

Another article by Dentistry Today explains the dental insurance companies’ methods:

Insurance companies can delay and even deny payments for dental care, no matter if the treatment is obligated in the plans or not. They can use a variety of tactics.

It usually starts with losing the copies of the patient’s documents, saying they never received in the mails. They may use false information with unnamed or unlicensed personnel to deny the covered procedures.

One common method by the dental insurance companies is that they may set the coverage for services that are necessary to everyone at a shockingly low rate to discourage patient care.

According to the study by Project HOPE from The People-to-People Health Foundation, Inc:

The Affordable Care Act (ACA) requires large-group health insurance plans to spend at least 85 percent of all premium dollars on health services and quality improvement activities.

This amount of investment is known as the medical loss ratio (MLR).

For smaller health insurance plans, the MLR has to be at least 80 percent. It is compulsory for plans that do not achieve minimum MLRs are required to pay refunds for the consumers. Based on this requirement, the ACA also excluded dental insurance and other specialized plans.

However, the consumers in Cape haven’t received the good value following their insurance plans. This means that the dental insurance companies have raised the complexity of their methods to avoid paying for even standard plans.

Overall

It will be challenging for legislators to create specific rules and policies to protect the full rights for the consumers. But the solution is not entirely impossible.

Legislators can approach the marketplace through secretive methods to collect evidence and find better ways to eliminate bad dental insurance companies.