Dental insurance is, in fact, a way to prepay dental services. For example, if you pay $30 per month, or $360 per year, in premiums, you are entitled to get several types of services for free. Typically, these are "preventive services", and they include X-rays, examinations by the doctor, emergency fees and regular, maintenance cleanings. In addition, patients enjoy an allowance of $1000 to $1500 to be spent toward any covered dental expense during that calendar year.

Depending on the severity of the problem, insurance companies will pay a percentage of the fees. For example, dental fillings may be paid at 80% of their cost, while crowns are covered at 50% of their cost. These percentages apply to the "basic services" and the "major services" categories, respectively.

This type of insurance is called "indemnity" or "private" insurance. The deductible - or the money you would have to pay in order to get your benefits - is usually very low (or less than $50 per year). Plan participants may choose any dentist they desire. Patients are often seen without any delays during regular visits, or even during emergencies. This is the preferred plan by patients and doctors alike.

Other types of dental insurance include the HMO's and the PPO's.

HMO's, or Health Maintenance Organizations, became very popular during the 1970's and 1980's. For the first time in the history of dental insurance, an affordable, readily available plan became accessible to the general public. In the HMO scenario, patients pay very low premiums, about $5 to $15 per month (on the average). This is very little money in one calendar year. And so the plan poses all kinds of restrictions on services covered. Also, patients must choose a dentist from a list of participating dental clinics. These clinics are often very busy due to the large number of patients that are assigned to the office. The dentist is bound by his contract to see all the patients assigned to him. Delays on first visits (or even on emergency visits) are quite common. Many wait two and three weeks before they can see a dentist. And most patients do not see the same dentist on subsequent visits. Unfortunately, the quality of care tends to drop as well.

The PPO, or Preferred Provider Organization, was created to eliminate some of the problems present in the HMO's. Developed in the late 1980's and early 1990's, emphasis was placed on selecting good dentists who could serve as the insurance company's quality-keepers. Premiums rose to about $20 a month. Companies developed a more equitable payment schedule for the dentist. The "preferred provider" did not need to keep such a busy office as the "HMO dentist." While the insurance companies kept the dentists happier, they failed miserably with the patients. Restrictions in covered expenses continued to create patient dissatisfaction. Patients still needed to select their dentist out of a list of providers. Higher "out-of-pocket" fees were charged whenever a patient chose a dentist from out of the program.

The old adage, "you get what you pay for," helps explain why most HMO's and PPO's are inefficient at best. No business in the world will survive by proposing: "Here's $150… please give me back $1000 in benefits!" Insurance companies survive only because people do not utilize the benefits as fully as they should. Insurance companies have long realized that people only need insurance when they set out to "fix" their mouths. Once it is "fixed," most of the expense is purely maintenance. And patients keep on paying their premiums because they fear something "really terrible" may happen to them. And they want to have insurance just in case!

On a personal note, I believe that the worst problem posed by the third-party nature of insurance company's coverage is how they have subtlely dictated what patients can or cannot get done at a dental office. If we were a cardiologists office, and you needed by-pass surgery, but your insurance will not cover it… would you accept it? Probably, you will go right to the company's office and raise some kind of hell, right? Well, they do this to us all the time. Your dentist may indicate that you need "deep cleanings," but your plan only covers regular cleanings. Sometimes, because you must pay out-of-pocket, you may opt not to get the much-needed treatment. Well, I say: "If it is needed or indicated, please pay for it!"

Another scenario is the painful dental emergency. Oftentimes a tooth is infected and it needs a root canal. But your insurance company may not pay for a root canal (or your out-of-pocket expense is too high), and you opt to have a reasonably good tooth extracted (or "pulled"). When confronted with such a decision, 100% of the people will choose the better treatment, or that which allows us to save a tooth and provide better care to out patients. But when these decisions are hampered by insurance companies, the patients freedom to choose is lost. And that is a travesty!

Patients should choose dental insurance plans that fit their needs. An "indemnity" plan is always the best provided you can afford the higher monthly premium. You must try to understand what percentage of coverage is given to the three main types of services in dentistry.