According to an analysis in the New York Times, the Affordable Care Act (ACA) brought a new era of complex health and dental insurance products — higher premiums, narrower provider networks, and higher deductibles. The idea was that consumers bearing more financial risk would be more cautious about healthcare spending. In reality, many people end up struggling with surprise bills, paying hefty amounts for out-of-network care, or avoiding care altogether.
Why Out-of-Network Surprise Bills Happen
Emergency rooms and urgent care centers present a common insurance surprise. After being treated, patients often receive unexpectedly high bills from their insurance company — frequently because a provider at the facility wasn’t actually employed by the hospital and wasn’t in-network. A New England Journal of Medicine study found that 22% of the time, patients treated at an in-network emergency room still received a bill from an out-of-network doctor. Texas had one of the highest rates of surprise billing in the country, at 89%.
Hospitals and insurance companies often point fingers at each other over these bills. Many doctors working within a hospital aren’t on the same insurance plans as the hospital itself, so after treatment, they bill the insurance provider separately and negotiate their own rates. When the insurer and provider don’t agree on a rate, the patient is often left covering the difference.
How This Applies to Dental Insurance
A New York Times/CBS poll found that 46% of Americans said they had trouble affording health care. Dental insurance is often treated as an unnecessary expense and put off until an emergency arises. Many insurance providers don’t clearly explain fine print details — like out-of-network surprise billing — when selling a plan. As a result, patients paying high premiums often assume they’re fully covered when they’re not.
It’s worth talking directly with both your insurance provider and your dental office about coverage for emergency and urgent situations, so you know what to expect before you need care.
Why Dental Health Still Matters
Dental health might seem like a lower priority than other healthcare needs, but it can affect your overall health considerably. A toothache or bleeding gums can be a sign of underlying health problems that only a dental professional can properly diagnose. Premier Smiles believes in offering excellent dental care and helping patients find affordable, customized plans so cost never has to stand between you and a healthy smile.
