Dental Insurance Payments: Less Money for Dentists

Post comments on dental insurance payments to dentists to our blog.

Dental insurance companies paying lessSix out of seven dentists (87%) say that dental insurance covers less and payments have dropped, this survey found.

Only 13% of dentists report that insurance payouts haven’t changed.

“The best definition I have heard for an insurance company is a bank that does not give your money back,” griped one dentist.

Dental insurance companies are slower to pay

  • “We are also having a harder time receiving payment….Most companies are sending bulk payments monthly.” (Georgia dental office worker)
  • “Reimbursements are slower, smaller and more antagonistic to gain.” (General dentist)


  • “The best definition I have heard for an insurance company is a bank that does not give your money back.” (General dentist)
  • “Insurance companies could care less about the financial health of the dentist and the dental health of their patients, Insurance (more correctly, a benefit plan) is a scam!” (New York dentist)

How come dental insurance
has so much power over fees?

  • “Insurance companies are getting too much power. No way should they be able to dictate our charges for procedures they don't even cover.” (Pennsylvania dentist)
  • “And on top of that they limit the doctor's fees on procedures not covered by the policy…” (Maryland dentist)
  • “This is the perfect storm insurance companies have been waiting for. Several have reduced reimbursements and decreased coverage on certain procedures. Also attempting to dictate fees for non-covered services.” (Michigan dentist)

Employers offer less insurance

  • “Employers have reduced coverages across the board.” (General dentist)
  • “Not so much because of recession but more as way to continue to offer dental insurance plans that are affordable to employers. I have seen more of a decline of employers dropping dental insurance as a standard benefit for employees.” (Pennsylvania dental office worker)

They just won't pay

  • “Patients have asked if we raised our fees, but their insurance just pays less.” (Texas dentist)
  • “STILL $1,000 annual max? Is this the now only thing on the entire planet that has not gone up in the last 50 years?” (Illinois dentist)
  • ‘Coverage payments have not increased in the last four years. Benefit coverage is more restrictive & frequency limitation have increased dramatically. Overall, the subscriber is getting far fewer benefits than before.” (Connecticut dentist)
  • “Each year dental insurance companies cover LESS & LESS!!” (New Jersey dentist)

Will dental implant dentistry be covered someday?

  • “I have not seen that insurance has changed. It definitely has not gotten any better. I have worked in the dental field for 13 years and have handled insurance for 8 of those. I have not seen any plans start raising their maximums to compensate for inflation. I have only seen a small change as to where 1 maybe 2 insurance companies are starting to pay for dental implants.” (Georgia dental office worker)

It all depends on the dental insurance plan

  • “It depends on the dental plan. Some plans have increased their allowable amounts and dental coverage, others have decreased and some have stayed the same. It can vary within the same insurance company.” (Minnesota dentist)
  • ‘Claims are paid faster.” (Idaho dentist)

Your crown had better not need replacing…

  • “What's up with insurance only paying for a crown re-cement as ‘once in a lifetime' benefit? If another DDS re-cements the same crown, they get paid, but not me. Makes no sense!” (General dentist)
  • "A lot of insurance companies have now made the ‘waiting period’ for replacing a crown 10 years instead of 5 years!” (Alabama dentist)

Their policy: deny, deny, deny

  • “It appears that more services are initially denied, but eventually some get paid with appeals.” (Tennessee dentist)
  • “The insurance companies continue to ‘play their game’. That is exactly what needs to be changed.” (Illinois dentist)

Things dental plans really should cover

  • “They are slower to pay and refuse to pay for composite cores.” (General dentist)
  • “They have ‘rules’ they pull out of their behinds… I hate when procedure A is coverable and Procedure B is coverable, but they're not both payable if done on the same calendar day… I just cannot imagine the employer agreed to save money on premiums knowing that it causes this dilemma for their employees.” (Illinois dentist)

Just plain ridiculous

  • “It is the internal policy of insurances NOT to pay right away any claim more than $500. Claims NOW get LOST, which was not the story before the recession. Now is the time for all dentists to start charging for administrative procedures like calling insurance, sending paper claims, confirming insurance and benefits, sending paper invoices to patients, calling the pharmacy, receiving and sending faxes to insurance and /or to patients, etc.” (Florida dentist)
  • “Clearing houses for electronic claims are sending paper claims despite the fact that we have the provider # given by the insurance company on the patient's card.” (General dentist)
  • “Today we found out that a RCT re-treatment was denied. We called & found out that a ‘memo’ arrived changing the benefits. They said it was ‘never enforced’ before. If RCT was not done when covered under this plan, than the re-treatment will not be covered. Thus a RCT done 15 years ago will not be covered for a retreat even if you had this insurance for 5 years! Unreal!” (Florida dentist)
  • “They've reduced payment for D4341 to D4342 (stating pt only need 3 tths to be deep cleaned instead of the whole quad) They've started to use ‘POLICY’ that pt needs to wait at least 45 days AFTER regular cleaning to be eligible for Deep Cleaning, which is completely inconsiderate of patient's benefit. Deep cleaning is best to be done within 4wks from the routine dental cleaning, and they are denying payment if you don't wait for 45 days. What if patient has severe bleeding gum, and they still have to wait for 45 days? They've started to deny payment for Buildup on a Crown. Forced us having to submit the narrative and x-rays at least more than 2 times to appeal and delayed payment around 2-3 months to finally get the Buildup approved for payment.” (General dentist)

Not a lot of dental management choices

  • “Dental insurance companies should not be allowed to set fee caps for network providers. It is ridiculous that our procedures get discounted by so much that it doesn't cover the cost of the procedure to do it. Yes, we can drop out of networks, but in this economy, doing so can mean the end of your practice.” (Kentucky dentist)

Dental health plans: A vicious circle

  • “It's been going on for years and is now accelerating because money is tighter. Fewer premium dollars = lower payout . And it will continue until those controlling the money get you to do it for less and ultimately own you by servitude — just as Monsanto took over all the family farms. Now we have food that robs your health, but it's relatively cheap.(well, not really, is it?).” (New York dentist)
  • “This is how the insurance companies keep employers providing insurance. The employer can't afford the premium increase for the same coverage, so they decrease the coverage (fl- on children 1x yr down from 2x year, bw 1x tr instead of 2x yr etc). Then when the patient comes in for their appt we ask them if their ins coverage has changed and they say nope-same ins company as last year. Then when the claim is paid the surprise comes in for the patient and us- their preventative appointments are no longer covered at 100%. Pts unhappy because they did not know about changes, and we didn't know because there are so many different policies out there. Insurance game still the same, set up for insurance companies to win by receiving same or more premium payments, pts lose as they receive less treatment coverage, dental offices lose as we are stuck in middle between ins and employees and we end up eating some profits by writing off small procedures that pts did not know had been dropped from coverage , so we can keep up pt good will. And then we get to help BAIL OUT ins companies thru federal gov't Obamatics with taxes. Seems like small business owners are the ones that pay the stiffest price when it comes to all federal bailout programs etc. If we ran our businesses like many of the big boys that fed bailed out last year, the only bail out we would get is from jail!! I could go on and on all day on this subject matter but need to be more productive than to write for hours on email responses.” (Oklahoma dentist)


Note: Survey sample included 76 respondents. Posted 5/11/2010

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