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Dental insurance is more like a coupon, not a security blanket - YouTube
Channel: Moonlight Beach Dental
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hi I'm dr. Nicole fain the owner of
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moonlight beach dental and this is part
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of a video series on dental insurance to
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help our patients and consumers in
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general better understand how it works
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and what that really means so for for
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most people
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dental insurance and any insurance we
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think of as security right if something
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goes really wrong I'm gonna be covered
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so I have medical insurance I've
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actually been a perfectly healthy person
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I take no medications the only thing
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that's happened to me significantly in
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the past 18 years is that I've had a
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baby so I really am not using my medical
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insurance other than for a checkup but I
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have it in case anything happens to me
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like if I was in a coma or car accident
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or something horrendous happened I know
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that if I had a million dollar medical
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bill that I'd be covered but dental
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dental insurance isn't like that at all
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so dental insurance came out in 1970 and
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what's very unusual about it is that it
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hasn't changed at all since its
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inception back then so you used to be a
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really great thing you've got a thousand
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dollars worth of benefits now just so
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you're aware that hasn't changed at all
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with inflation so back in the day in
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1970 you were covered for several root
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canals if you needed it several crowns
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if you needed it if you were breaking
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teeth if you needed anything restored
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insurance would actually cover it but
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nowadays that same $1,000 if you take
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into account inflation and what each
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procedure now costs and the billable
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procedures you're not gonna believe this
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that same $1000 which is still the norm
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a thousand to fifteen hundred should be
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twelve thousand three hundred and
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sixty-five dollars that is just crazy
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so no insurance out there is going to
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pay twelve thousand dollars
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essentially what we call insurance is a
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benefit so it's a benefit it's a coupon
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so instead of a crown being $1,500 as
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the cash fee their insurance is going to
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say we'll only pay a thousand dollars
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and you the patient are only going to
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have to pay half of that if we deem the
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crown isn't
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so you're saying wow I have a $1,500
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procedure and my out-of-pocket is only
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$500 that's great and I still have
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another $500 to use and most people
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perceive it as getting their two free
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cleanings and checkups a year so they're
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don't get me wrong if you haven't dental
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insurance keep it if someone's paying
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for it your employers paying for it
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that's wonderful but you really have to
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understand what you're getting out of it
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is just a very very minimum in what
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they'll cover so it's a great coupon
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it's better than having nothing but if
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you are someone who doesn't need much
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dentistry or you're not really in fear
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of having something go on you'd still
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want to be covered to a thousand dollars
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worth so if you were in a horrible bike
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crash like my cousin where she broke ten
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of her teeth in her jaw her medical
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insurance covered for her jaw to be
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fixed but her teeth were left for her
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out of pocket so she got one tooth
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covered which one of the teeth out of
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the 15 that were broken
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she got a root canal and crown covered
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and the rest she had to find a way to
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pay for that was over 25 thousand
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dollars worth of Dentistry and there's
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no letter of appeal we can write on your
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behalf
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there's no photos we could submit that
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would show the insurance that this is
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actually dentistry that you need that
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isn't just simply an elective procedure
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so therefore this whole security notion
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isn't really secure you're not really
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going to be taken care of by your dental
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insurance you're only going to be taken
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care of up to $1,000 the other thing
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that's really interesting to me about it
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is that your benefits and premiums don't
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change
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so unlike medical insurance where I
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could pay my deductible and then
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exercise a much larger portion say I
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needed a lot of Dentistry that year like
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my cousin she could have paid say 5,000
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out-of-pocket to exercise the 25,000 in
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dentistry she needed there's actually no
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such clauses that will allow you to flex
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your pay that way then since then
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actually her accent was almost 10 years
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ago she hasn't had a cavity well her
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insurance premiums didn't go back down
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saying oh now you're paying for each
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year is your cleanings and your checkups
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so we're gonna have you pay less
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so I really don't like that the benefits
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don't flex on your behalf based on your
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level of need it should be something
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that correlates a little more like
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medical insurance the last part that I
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find really interesting and bit
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upsetting is now that I'm in my 15th
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year of practice that there's no payment
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based upon credentials
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so essentially insurance views me
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exactly the same as the me that was one
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month out of dental school so the fees
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that they're paying are based upon the
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fact that they're viewing the quality of
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care to be equal from a baby dentist who
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just graduated from school versus
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someone like me who's completed over a
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hundred thousand dollars in extra
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continuing education to explore things
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like understanding complex bites and
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cosmetics so it's a little bit
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disturbing that they want to pay $17 for
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a comprehensive exam when we're spending
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over an hour hour and a half with each
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patient working up their case and
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exercising all the knowledge that we've
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invested in so that's really something
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to consider when you're looking at
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someone who says well this isn't it work
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dentist and I really want to go to them
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because they're gonna take more of my
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insurance you really have to be careful
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at what you're looking at because
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insurance will still pay for an
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out-of-network provider as long as it's
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a PPO plan not an HMO plan they'll pay
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it at a different percentage but a lot
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of sense it's still very favorable for
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the patient so I just wanted to have
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people be informed about what they're
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doing and what they're making their
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decisions based on because it really
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shouldn't be just on it the persons in
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network with the insurance but it should
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really be on the quality of the provider
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the level of donor care that you're
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gonna need and also the fact that you
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want to make sure that your dentist is
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well trained is gonna stand behind their
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work so just to give you an example many
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of the insurance fees that people are
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not accepting some people I had a
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patient yesterday that said she's not
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even using hers because there was only
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one dentist in town and I'm in San Diego
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a very large area that would take her
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insurance and it was a clinic and she
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just felt the quality of care wasn't too
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standard just so you're aware as a
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provider some of these insurances are
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a couple hundred dollars for a procedure
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that actually in materials cost and time
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cost me twice that so a lot of dentists
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are gonna have to take a loss or make up
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for it in volume on what they'll do to
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compensate for what the insurance will
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reimburse so the issue becomes do you
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really want someone just trying to crank
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out dentistry seeing ten people at a
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time and using subpar materials so that
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they can try and make a profit off of
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the small portion they're being
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reimbursed for or would you rather
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choose someone that's more conservative
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with their approach who takes a lot more
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time with their patients who's focused
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on the quality of care who warranties
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their work to me that sounds like a much
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better investment versus well my
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insurance paid 25 percent more for me to
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go to this person this is this person so
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I hope you find this information useful
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because I've really found this process
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enlightening in my 15 years of practice
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I find it very unfortunate that
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insurance won't pay for the level of
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care that people deserve and the level
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of care that I would want for my own
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mouth and for my own family so be
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careful when you're choosing a plan and
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feel free to call any of our front desk
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here at our office they're all going to
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be advocates for you and your health as
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well as advocates and helping you
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utilize your dental insurance benefits
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thank you for taking the time to listen
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to this video
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