The role of insurance in dentistry: needs vs. profit

What happens when your dentist recommends a specific course of treatment, but your insurer won’t cover it? A lot of people end up making the assumption that the treatment is somehow unnecessary – and even resenting their dentist for recommending it.

Before you come to those types of conclusions, however, look at it this way – a dentist takes a clinical approach that has your health and well-being in mind, while an insurer is driven by one thing: their bottom line. So who has your best interests at heart?

In addition, many insurers have quietly decreased dental coverage over the last few years. For example, some plans will now only cover checkups every nine months, instead of the usual dentist-recommended six. Does that mean you only need to have your teeth cleaned every nine months? No. It simply means that your insurer is only willing to pay for it that often, despite recommendations from the Ontario Dental Association, the Canadian Dental Association, and other associations in Canada and the US. If your health is a priority, you should continue to visit every six months, and factor the cost into your yearly budget.

Remember, the insurance company isn’t diagnosing the problem, they’re just paying for the treatment. So if they aren’t willing to cover a crown, that doesn’t mean you don’t need one. (It just means they’re not willing to pay for it.) With declining benefits, it’s your coverage that’s being reduced. Your needs are the same. So the solution is not to dial back on your care. Instead, finding different ways of funding the care you need is crucial to maintaining your healthy smile.

Most dental offices (including ours) have a variety of payment options that can make dental care affordable, even if you’re not being covered for 100% of the cost. If you have questions, please call us at 905 637-5463 (KIND) – we would be happy to discuss the flexible payment options and other financial solutions that make it easy for our patients to afford the best possible care for themselves and their families.


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