The Real Cost of Dental Insurance
Learn how dental insurance is making your dental care more expensive.
Dental Insurance Break Down
Numbers shown are used for understanding and does not represent any specific dental insurance company or dental office.
Insurance Negotiated Pricing
70%
- 30%
Insurance companies negotiate fees with in network offices. These fees can be as low as 50% of the office fee. Meaning the office can only charge patients with their insurance 50% of their original fee. I usually see around 70% of in office fees.
Reimbersment Rates
90%
- 10%
Reimbursement rate refers to the percentage of reimbursement that the dental office actually collects. I've seen collections as low as 70%. A good team will collect 85%-95%.
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Why is this number not 100%?
Insurance companies make money by not paying claims. Insurances will deny claims for ridiculous reasons to make dental offices fight for their reimbursement. In many cases insurance companies will not pay at all.
Cost of Employees to File and Collect Insurance Reimbursements
10%
- 10%
Dental offices accepting insurance have dedicated team members to communicate, check coverage, file claims, manage denials, etc. I've seen the cost of these team members being upwards of 10% of the offices production.
This adds up to be a 50% loss in production.
Most offices overcome this loss by one or a combination of the following:
- Volume. They will see as many patients as possible to produce more.
- Increased fees. Meaning that patients without insurance are essentially subsidizing those patients with insurance.
- In House Specialties. Some office will have rotating specialists to keep all of the work in house.
I think this is completely unfair. Volume dramatically reduces the amount of time the doctor has with each patient and increased fees creates a financial barrier preventing those without insurance from getting the care they need.
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Dr. Andrew Tomes, DMD
"I have seen where my industry can improve. Patients need transparency in pricing, and we need to stop pretending that dental insurance is helping the access to care."
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Eliminating insurance from my business model has allowed me to take an average of 30% off the UCR (Usual, Customary, and Reasonable fees) to lower the financial barrier and provide transparent pricing to all patients regardless of insurance coverage.