So your employee John Doe goes to the dentist. He has the dental HMO plan. John did his research and found an in-network HMO dentist so he could be sure to pay the negotiated discounted rates he was told he would pay. But when John got to the dentist, the dentist said: “Plan shman! You need $2,861 in work and I can help you with that- just sign on the dotted line and we will fix you right up!”
And this is where it falls apart.
Dental insurance policies are NOT THE SAME as your medical insurance policies! And unfortunately just because someone has the word “Doctor” in front of their name does not mean they are inherently trustworthy. It is bizarre to me how people trust what their doctor/dentist tells them about their insurance policies. Would you trust me to write you a prescription? You shouldn’t. I didn’t go to medical school. And Doctors don’t know how your insurance policy works either.
I host at least 50 open enrollment meetings per year where I explain to employees how their medical policy works, and share my personal tips on how to navigate the system, and it’s great. Then I start talking about how dental insurance policies work- and I start getting heated.
It is important to me to not only explain how their dental policy works, but to empower employees to make the best decisions!
Here’s what you need to do:
1. Bring a copy of your plan with you to the dentist. Tell them to keep a copy in your file. I realize this sounds cumbersome, and we’ve never had to do this with our medical policies but this is not the same arena. When the dentist high pressures you saying “this crown will be $1200 and lucky you- we can do it right now” you need to slow down the process and say- “Let’s take a look at my plan.” (Bonus tip: Anything in life that has to happen ‘right now’ is probably not a good idea.)
2. If you have a PPO– Ask for a predetermination of benefits. This is a simple process where the dentist tells your Dental Carrier exactly what procedures they believe you need, and the Dental Carrier sends you a copy of exactly how much it would cost you. This forces the dentist to run the numbers by the Carrier, gives you time to think about things, and have the 100% correct numbers in front of you.
3. If you have an HMO – review the plan you brought and have them show you the dental codes. Here’s the big one I tell my people: If they say, “This code [procedure] isn’t on your plan”, then you say “Why not? Why do I need that then?” There should be no mystery!!!! Look- of course it’s possible for something to be not covered on your plan. Maybe it’s cosmetic. Maybe it’s a ‘buy up’. But you should know either way. Then you can make your own decision.
4. Do not sign a financial agreement unless you agree with that amount. Please please please! READ what they are putting in from of you! You are not signing saying that your insurance will cover everything you are signing that YOU WILL PAY. We cannot negotiate after you have signed that agreement (or at least it is much harder). Negotiate first. Medical/dental insurance is the only piece in our lives where we have no idea how much something will cost until after we’ve bought it. That’s not right!
5. Ask questions! You didn’t go to dental school! You aren’t dumb! This is just not your specialty! If something doesn’t sound right- ask questions until it makes sense. If it still doesn’t make sense- go back to your HR person or insurance advisor and get clarification. Those people are paid to help YOU.
6. Don’t be afraid to leave. True story. I walked into a dentist office, looked around, and didn’t have a good feeling. I started filling out the paperwork, sat in the waiting room for 20 minutes, then got up and said “This isn’t going to work out.” And I left. I’m glad I did. Trust your gut! Remember – this is a business! This is your dentist- not your mother. There are thousands of them. So find one you trust. Ask your friends, co-workers, and neighbors. Hell- ask me. I know people…
We need to start spending as much time comparison shopping our medical and dental care as we do for our new cars. Can you imagine walking into a car dealership and saying “Whatever you think, Dr. Sales. You know me…”
No. They don’t.
Start the conversation. You’re worth it.