Dr. Drew explains how Dental Benefit Plans work

For my second column, I would like to shed some light on a dental subject that can be very confusing and frustrating:  Dental Insurance.

There are a few basics that sometimes aren’t clear:

The true origin of insurance was to protect groups from catastrophic loss of property with full replacement value.  Therefore, dental insurance might be better described as dental benefits.  In other words, for those who have dental benefits it is designed to help with the cost of dental treatment – it was never intended to cover all dental costs. 

While insurance premiums are consistently on the rise, the benefits available have not increased proportionately.  A typical dental plan in the 1970’s may have had an annual maximum of $1000 (which would be $5-6000 in today’s dollars).  Many plans today still have that same $1000 maximum which simply doesn’t go as far, and may have many limitations in terms of how those benefits can be accessed.

We often are asked if a procedure is covered.  It is rare that we know because there are literally thousands of different plans – these plans are specific contracts between the employer and the insurance company based on what the employer is willing to pay for.  We can help get this information, but insurance companies are very strict when sharing information.  These contracts also don’t have anything to do with whether proposed treatment is necessary, or appropriate for that individual. They simply determine whether there are benefits available for that procedure.

We understand that Insurance benefits are very important to those who are fortunate enough to have them, and we work very hard to maximize the benefits to which you are entitled.  What can be very frustrating is that benefits are often only available for the procedures that tend to last the shortest amount of time.  For those procedures that are longer lasting, the co-pays tend to be higher, and in some cases are not covered at all.  This is not the dentist looking for an opportunity to upsell their patient, but simply sharing all the options that are available.  It is always the patient’s choice as to which option is selected based on their values, cost, time, etc. and sometimes that choice is to do nothing.

It is very important to recognize that your dentist is providing you with different options based on the conditions that we see.  It is our belief that it is inappropriate for us to diagnose our patients based on what we think they can or cannot afford.  As we mention to our patients, we will provide you with a variety of options that all have varying consequences and different costs, and as long as the patient understands those consequences, we will support whatever decision they make. 

This is the process of informed consent which is very different than the days of, “Do whatever you think is best doc.”

The bottom line is that dental decisions are often big ones in terms of both the types of procedures and potential cost.  Do not be afraid to ask questions so that you understand your options before starting significant dental procedures. 

Should you have any questions that we might help with, please contact us at [email protected], or call at (705) 788-3067.  You can also get additional information at our website www.drdrew.ca.

Dr. Drew Markham Dentistry was built in 2008 and is located in Commerce Park, in the southeast corner of Hwy 60 and Hwy 11.


Drew Markham

Drew Markham DDS

Dr. Drew earned an Honours Bachelor Degree in Physiology from the University of Toronto in 1993, and his Doctorate of Dental Surgery from the University of Michigan in 1998.

He has undertaken extensive post-graduate training in cosmetic and neuromuscular rehabilitation, which led to further training in orthodontics, sleep dentistry, and dental implants. Dr. Markham has fellowships from the Las Vegas Institute (LVI) and the International Association of Physiologic Aesthetics (IAPA). He has served as one of three Canadian clinical instructors, and also as a regional director for the Las Vegas Institute since 2008. Most recently he served as president of the International Association of Physiologic Aesthetics – a 500 member organization dedicated to the comprehensive care of their patients.

Dr. Drew along with his wife, Janet, and their 2 sons, came to Huntsville in 2005.