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Why Dental Insurance Is All Smoke and Mirrors

dental insurance smoke

By Hilarie Steele, RDH CEO Operations and Relationships
at Best Natural Smile, Santa Monica, California


Dental insurance is impractical and outdated and simply hasn’t caught up with the
modern world.

Lack of time, inconvenience, and anxiety are common factors as many people not only dread the experience of going to the dentist, but also the price tag if they end up
needing treatment

Procrastination becomes the name of the game.

The problem is, the longer you procrastinate, the more likely you are to need major treatments.

It’s a viscous cycle that keeps people from getting the regular smile maintenance they need to avoid the possibility of costly repairs.

When it comes to old school dental insurance, most people find themselves in one of the 3 categories below.

Here are 3 common dental insurance conundrums.
See if you relate.

These are people just like you and I who are stuck in the “old-school” dental insurance mindset and think they’re out of options. Erika has employer-provided dental insurance, Faith is self employed and doesn’t know where to find it and Todd is in dental insurance limbo and knows he needs it.

Do any of these scenarios sound familiar?

Ericka the Executive

Erika has been a part of an employer dental insurance plan for her entire career. She trusts that it is the best and only option available to offset the cost of her smile care.

To put it plainly, Erika’s dental plan sucks. Let’s find out why.

Her paycheck has a recurring monthly premium deduction that she doesn’t pay attention to and has never really questioned where her money’s going, how it’s being used, or what specifically it covers in regards to her smile care. She is not aware of all the rules or how it works because of the red tape necessary to sift through her plan paperwork. She has never looked at it!

What Erika doesn’t know is that she is paying $600 a year in premiums.  After visiting us she finds out she is in need of a porcelain crown. Her benefits are reviewed in our office and she discovers that additionally there is a yearly deductible of $100. It doesn’t stop there. Her insurance plan will cover the crown at 50% which leaves her with an immense additional out-of-pocket expense. 

She believes that there are not any alternatives. Erika has accepted that traditional dental insurance is the only answer.

Faith the Freelancer

Faith is a gig worker who is seriously time-poor. She’s so busy managing her workload that she doesn’t even have time to think about dental insurance, what it means, how it works, or where to find it.

She’s concerned that because she has a non-traditional career she has nowhere to turn, no coverage possibilities, and is out of options. She fears that even a regular dental visit might deliver news she doesn’t want to hear and leave her financially upside down so she avoids it at all costs.

Her smile is important to her. Being healthy is important to her. How she looks and feels is important to her. But finding a solution seems impossible so she pushes smile care to the end of her list.

Todd the First-Timer

Todd is a healthy 26-year-old who has been receiving regular smile care his entire life. Because he’s always been insured under his parent’s plan, he’s never even thought about how his care is covered.

Todd was recently kicked off his parent’s dental plan and is officially on his own looking for coverage to continue receiving proper smile care. He knows that he has the option to pay cash and like Faith the Freelancer, he doesn’t know where to begin.

He’s in limbo during this transition and is worried that he will fall behind in receiving necessary regular smile care.

There’s a myth out there that there are no options for people with employer coverage, for those who work as freelancers, or for those who are simply paying cash and don’t know where to turn.

dental insurance

But is this actually the case?

Are there other ways to get top-quality smile care without having to fork out costly premiums or track down an insurance carrier? We believe you should be able to get access to high-quality, affordable care without the need for an employer plan or the stress surrounding how to access it.

We’ve crunched the numbers and have taken a closer look at the outdated dental insurance system to show you that dental insurance in almost all cases, is definitely NOT worth it.

Make sure you read to the end to discover our alternative to dental insurance that will completely change the way you think about dental insurance and give you the solutions you need to end the struggle.

A Closer Look Into The Dental Insurance System And How It Works

dental insurance flower

Until more people wake up, this broken system will stay in place. When it comes to dental insurance, people accept conditions that in any other industry would be stopped immediately. Traditional dental insurance is riddled with a lack of transparency and neglects the patient’s best interest, which should be supporting your smile on a path to longevity and managing the health of your oral microbiome, there by leading to less smile breakdown and unnecessary financial outlay.

The cost of dental insurance is accepted as part and parcel of receiving smile care no matter what the terms or deliverables are.

So Let’s Break Down How It Works

First, you pay a monthly cost tied to a year-long commitment in advance of any visits.

EX: $50 per month x 12 months = $600 yearly premium

Second, on top of the cost for your 12-month commitment, you pay an additional yearly deductible.

EX: $75 yearly deductible = $675 out of pocket cost

Third, your coverage has a ceiling on the amount that can be spent each year regardless of what you need to complete your recommended care.

EX: $1000 yearly ceiling coverage – $675 out of pocket cost = $325 left to spend

WHAT?! Ridiculous. If you should need additional smile breakdown repair, that’s barely enough to get started.

A Journey to Proper Care

dental insurance trees

Not to mention, there is a long list of rules and regulations that are micromanaged by your dental insurance administrator. They decide if your recommended care is approved and dictate what type of care that remaining $325 can go towards.

EX: You have a cavity and are in need of an aesthetic white-colored filling. Your dental insurance administrator will not only decide if you care is approved, but they may also have a ‘downgrade rule’ that states a silver mercury filling, which we know to be toxic, is the solution. What?

And get this – IF they approve your care, they additionally determine that only a certain percentage of your remaining $325 can be used. Rarely allowing for 100% coverage of your recommended treatment. This puts you at risk for further dependence on their broken system, more out-of-pocket costs, and the potential to never fulfill your need and desire for a healthy smile.

EX: Your dental insurance has denied your dentist’s recommended solution of an aesthetic filling, which takes care of a cavity the appropriate way. They have, however, approved a downgraded silver mercury filling solution at a lower cost only to be covered at 80%. Now, of the $325 you have left to spend, you can only use a certain amount towards a toxic solution.

This is outrageous.

Your smile care is being based on people who don’t know you deciding what’s ‘best’ for you and sometimes only allowing you to have sub-par treatment. The primary focus of this backward system is on the insurance company collecting your money, instead of on you staying healthy.

It’s about time someone lifts the curtain.

dental insurance curtain

If you follow the examples you can see that this is misleading and causes stress and confusion. Traditional dental insurance is a nightmare.

To recap, the dental insurance companies impose a full range of conditions including:

  • Accepting or rejecting your desired dentist
  • Deciding what your $325 actually goes towards
  • Offering sub-par treatments like toxic silver-mercury fillings or metal crowns
  • Deeming what certain percentage of your $325 is allowed to go towards your care
  • Scrutinizing necessary treatment

Frustrating, Right?

The problems don’t stop there. Smile longevity and how to maintain your oral health and most importantly your oral microbiome should be discussed and decided between you and your professional health care provider. It should not be dictated by a stranger (dental insurance administrator) who has never met you and certainly does not know the kind of care you need.

Who wants to be looked at as just a number in a vacuum of administrative red tape?

Now that we’ve provided some transparency and laid it all out – it doesn’t take a genius to know why this profit-focused model of traditional dental insurance is broken and needs to be reinvented. It’s no wonder that many Americans are struggling to understand how this system works and starting to question whether it’s really worth it to go down the dental insurance route.

You’re not alone in feeling lost and frustrated with the current system.

Dental insurance companies function like any other business. They aim to increase profits and minimize losses at every opportunity.

Why Is This So Concerning?

Did you know that even before the events of 2020, a third of American adults hadn’t visited their dentists in over 12 months?

Based on our research, Americans voted that the #1 health care professional that they would like to see more of, was the Dentist. This won with an immense lead over other practitioners, even reigning over their Primary Care Doctor.

This is a concerning trend as a healthy mouth is absolutely fundamental to not only maintaining the oral microbiome but also to your smile longevity and overall bodily health.

People are caught in a Catch-22 with the belief that if they don’t have dental insurance that they can’t go to the dentist because the only option for care without coverage is paying 100% out of pocket. This leaves you without any incentives or benefits whatsoever.

But, what you need to do now is take all that thinking and throw it out the window!

dental insurance window

Why? Because the real cost of missing the dentist happens in the future. Over time, smile breakdown and emergencies are much more costly than maintaining your routine preventative care.

Minor dental issues can lead to more costly and financially devastating problems down the line.

A small neglected toothache can lead to a costly repair such as a full-coverage crown just as a pain in the jaw or a small ulcer could be the warning sign of something far graver.

The costs compound and the longer you neglect oral issues the higher the price tag down the road.

Every single person deserves a healthy smile that they can be proud of and the right access to smile care coverage. Something that is simple, practical, stress-free, and put’s your money where it belongs – in your mouth!

The tale of dental insurance as described in our blog is a very common, if not the most common, conversation at Best Natural Smile. When it comes to discussing my patient’s treatment plans, I have spent countless hours coaching them from “no to go” and their repeated frustration stems from the lack of accessing a system that makes sense and the need for one that is practical and encourages them to stay on track.

Delaying smile care is the leading cause of gum disease, tooth loss, and overall smile breakdown.

Not to mention that an unhealthy mouth is the silent catalyst to multiple debilitating chronic health issues. The end game is to protect your immune system by optimizing a healthy oral microbiome which then leads to a long life and smile longevity. Being aware of what your future smile may need along your way is vital so that proper planning and support can be achieved.

Losing teeth unnecessarily due to lack of access to care, confusion of how to tackle it or the assumption that your dental insurance had your best interest is proof enough of a broken system.

Problem Solved – Welcome to Shine Club™

dental insurance problem solved

Luckily, there is another way to manage your smile care costs beyond traditional insurance or paying cash strictly out of pocket.

We’ve created the best-in-class alternative to dental insurance OR no insurance at all.

Shine Club™ is a membership program tailored to your specific needs that not only prioritizes your pocketbook but also smile longevity.

Simply choose your situation, select a plan that’s best for you and we’ll get you on your way to keep your smile beautiful and bright.

It’s simple, practical, stress-free and the best part, it’s transparent.

You know exactly what you’re getting and say goodbye to those sneaky clauses, rejections, out-of-pocket costs, co-pays or downgrades. FOREVER.

We’re your smile advocates and we exist to empower you and your smile with the care you actually need and use.


dental insurance coin

A Real Return On Investment

A visit to the dentist is truly an investment in your future self. It’s an asset not just figuratively, but literally. Every cent goes directly into your mouth.

Shine Club™ prioritizes services you actually need AND prevents any potential smile issues before they arise.

As a member of Shine Club™, you pay far less than pesky traditional dental insurance and get WAY more.

In fact, you get a whopping 100% return on your investment and it’s your very best defense against future costs.

Access to quality, affordable, and transparent dental care should not be optional.

If you want to learn more about Shine Club™ and the options available to you then we’re at your disposal. You can contact us here to get in touch.

We can’t wait to see you shine!

A note from Hilarie:

As a dental hygienist and patient advocate located at Best Natural Smile in Santa Monica, California, I am a strong believer that the current dental space experience does not lend itself to achieving smile longevity, maintaining the health of the oral microbiome, or giving patients the tools and additional education they need to get there. We are stuck in an ancient system that creates barriers to accessing modern smile care.

I have made it my mission to disrupt the old ways of doing things in the dental space and create a more accessible path to maintaining oral health. I provide complimentary coaching to hundreds of patients. At the end of the day, the story is always the same: patients endlessly ask “How do I stop the breakdown of my smile and who can I trust to keep my smile healthy?”

If you’re interested in learning more or scheduling a complimentary coaching session with me please fill out the form below. From there, my team will reach out to schedule a time for us to chat. 

I’m so happy you’re here and can’t wait to see you shine.

hilarie steele, rdh

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