News and Updates

My Insurance Will Pay For It

By Mac Lee
Oct. 31, 2017 at 4:06 p.m.

I am hired as a consultant by dental offices across the nation to teach dentists and their team how to communicate to patients in an easy to understand language; a lot like I do with these articles. This October, I was in Worcester, Mass., and Rapid City, S.D. It's a fascinating job where I get to meet some really great people who are striving to give the best services possible to their patients.

About the only difference we see in dentists, their team and patients across the nation is accent. Worcester is pronounced "Wooster" and Rapid City is "Rapid." Of course, it is us who have the accent, especially traveling to the Northeast and yes, everyone seems to enjoy the Southern drawl. The problems that occur in Worcester, Rapid City or Edna, Texas are basically the same, which I find fascinating.

One huge, ubiquitous problem that always occurs, every day, in every dental office in America but has no solution is dental "insurance." When a dental office hears, "What will my insurance pay?" "I have dental insurance" or "My insurance will pay for it" they know mass confusion is about to occur.

"My insurance will pay for it."

When a patient say this, whether they are in Texas or South Dakota, they truly believe they have a plan that will pay for everything. In reality, dentistry is expensive and no third party is going to pay for expensive dentistry. It is numerically impossible to buy a cheap monthly policy and get thousands of dollars of dentistry for free.

The U.S. government may care about the nation's health but they care nothing about dental health in adults. Medicare pays zero for dentistry. Even for the most severe infections, there is no dental coverage. Private medical policies do not apply to dental needs either. This confusion by the public creates many problems for the dental office and patient alike.

"I have dental insurance."

This statement is different than the first one; without asking, you don't know what the patient is thinking and you will not know until you ask. The best question to ask is "and what does that mean to you?" They may say the same as above, thinking that everything will be paid for at no cost to them. They may be wondering how much insurance is going to pay, if any. They may be wanting to know how insurance is handled, whether you are on their plan or not, etc.

Since the contract is between the insurance company and the patient, only the insurance company can rightly answer the questions. Insurance is a huge, profit centered, multibillion dollar business and way too complicated for a dental office to be its spokesman. Their goal is to make money and the less they pay on a dental claim, the more they make. This reality drives a wedge between the dental office and the patient.

"What will my insurance pay?"

This question usually occurs when the patient is quoted a fee for dental procedures. It is an important question but it can never be truthfully answered by the dental office. It can only be answered by the insurance company and the contract. The contract is devised to make the company money, while providing a benefit to the patient. The benefit will never be more than premiums; simple mathematics.

While getting a "coupon" for dental work is a good thing, the bottom line is nothing is free. And no one but no one will ever, ever insure teeth. They may insure your house, car, motorcycle, etc. but never your teeth.

Dr. Mac Lee practices in Edna. He is an international speaker and trainer to dentists. He is dedicated to educate the public about dental disease. To learn more about dentistry, visit or call 361-782-7191.

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