Austin Smile Creations – Austin Dentist Blog

A blog about implant dentistry, cosmetic dentistry, general and family dentistry and a healthy living.

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A Failed System. Why Doesn't My Insurance Pay For This?

Given the current trend with the American healthcare system taking a drastic change, insurance is undoubtedly the hot topic among Americans. We have briefly discussed this trend previously, but have yet to dive into what insurance means within the dental world. More specifically, what it means for a practice like Austin Smile Creations where a whole body approach to optimal dental health means choosing an almost solitary journey and certainly a journey away from what insurance considers the dental standard.

Unlike many practices and dentists, Dr. Tor Gotun and the Austin Smile Creations‘ team choose a path that is far above dental insurance standards. There are not very many general practices that are adding bone, titanium mesh plates, and membranes to generate growth of new, healthy bone, so patients can plan to keep their teeth for a lifetime (or at least the most biocompatible and structurally compatible prosthetics available to their natural teeth- implants). Even the most necessary of procedures that allow patients to keep their teeth and therefore sustain a quality of life that cannot be compared, many dental insurances won’t even consider covering.

We must then explore what are dental insurance companies’ standards? Since there aren’t any regulations on how insurance companies decide on reimbursement levels, there is no way of knowing what they will actually pay until a claim is submitted and an explanation for that claim in sent back to the provider. Think of one dental insurance company. One dental insurance company has hundreds of plans underneath it’s umbrella. Now, take twenty-three large dental insurance companies, hundreds of third party, smaller insurance companies that link themselves to several of the large companies, hundreds of plans that an employer has the option to pick from, and hundreds of different guidelines for 10,000 different dental codes. To say in the least, it’s a mess and clearly meant to confuse it’s consumer- the patient. Consider everything outside of actually extracting teeth is optional. This is what dental insurance companies believe, an archaic principle. It applies to eighteenth century folks who didn’t have the technology and education available that we have at our fingertips today. So if everything except extracting a tooth is optional, it would make sense that dental insurance pays the least expensive alternative treatment, like a composite (white) filling at an amalgam (silver filling) rate. It would make sense that they have age limits, exclusions, pre-existing conditions, deductibles and annual maximums for the year. On one end, patients who need several major procedures performed to improve or even sustain a quality of life, the expense becomes mostly out of pocket for the patient. On the other end, patients who only need minor work and routine cleanings, end up paying a higher premium than what’s actually used at their dental office. Either way, insurance companies make money.

What we do different at Austin Smile Creations is that we have chosen to be of service to each patient. Patients have individual needs for treatment and therefore have highly specialized and individual treatment plans. If insurance weren’t in the business of making money, they would understand the medical necessity for procedures that dentists like Dr. Gotun provide: allografts, autografts, PRP, PRGF, sinus lifts, and bone augmentations to name a few. The Austin Smile Creations’ team knows the quality of dentistry they provide to each patient, and such, continue on this uphill battle against insurance companies standards. And we continue on this journey, refusing to accept an unacceptable standard of care.

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