Local Dental Care - Aetna Individual Dental Insurance

Types Of Discount Dental Plans - Coverage for Individuals and Families

DENTAL PPO PROGRAM

A dental PPO – preferred provider organization – is a individual dental insurance plan that uses a network of contracted dentists to provide a better value. Like a medical PPO, the dentists on the dental PPO network have agreed to a discount dental plan set of dental fees that have been established to be below the usual geographic area.

The dentists have agreed to the reduced fees in order to attract additional patients that might not have come to their office otherwise. The PPO network can replace some of the advertising that a dentist or dental group might rely on to bring in new patients. So you can see how medical and individual dental insurance plans are alike.

DENTAL CAPITATION PROGRAM - DHMO

A dental capitation or “Cap” program is another variation of discount dental coverage. They are sometimes referred to as Dental HMOs or DHMOs. Unlike the traditional discount dental plans described above, a dental capitation insurance plan does not use the fee-for-service system, but pays the dentist a fixed amount for each patient each month.

The capitation refers to this fixed monthly payment, which is determined from a combination of the premium received and the historic utilization of that group. While a way to transfer some of the risk of the cost for extensive services to the dentist, it can also be a source of conflict when a number of patients need multiple services from the same provider.

DENTAL REFERRAL or DISCOUNT DENTAL PLANS

A dental referral plan is not insurance. This type of dental plan uses a network of contracted dentists, like a PPO or DHMO, but the benefit is simply a discounted fee on their individual dental insurance plan. Nothing is paid on behalf of the member; they are simply entitled to a lower fee for their dental care. While this can appear to be of limited value, some referral plans are able to save their members a significant amount of money in dental fees.

Be sure when you are purchasing a discount dental plan that you are aware of the nature of the plan. A dental referral plan may help you with special fees at a limited number of dental offices, but it does not provide emergency benefits when you are away from home unless you contact the plan office and find a participating dentist where you are visiting.

GETTING THE MOST FROM YOUR DENTAL INSURANCE

Dental insurance is focused on the preventive and diagnostic services for higher coverage. To get the maximum benefit from your insurance plan, you need to consider the following issues:

• Is there an option that uses a PPO or DHMO network where you premium dollars will get more dental services? Often, using a PPO dentist can save you 10 – 20% from the usual fees.
• Whether you are in a PPO or not, will your dentist provide a treatment plan for a large amount of work? To be sure that your dental services will be covered by your plan, it is best to have your dentist send in a pre-estimate of services. That way you will know that the services are covered and what your portion of the costs will be.
• Can the treatment be set up in stages? If some care is more urgent than other services, perhaps your dentist can provide the services over two calendar years, thus utilizing two annual maximums. Annual maximums are usually $1500 or more, but that can be reached quickly with multiple services.
• Are there alternatives? Often, a dental problem can be solved in several different ways, all satisfactory and appropriate, but different. For instance, missing teeth can be replaced by dental implants, or by a bridge (in most instances) or by a partial denture. All of these are acceptable dental care, but the costs can vary widely. Talk to your dentist about why he or she believes that this treatment is best for you and if you still have questions, seek a second opinion.
• How often can you get your teeth cleaned? Some plans indicate twice per year, while others limit you to once every 6 months. If you have the second kind and your cleaning occurs before 6 months have passed, the insurance will not pay the benefit. Be aware of your plan coverage and the specifics before you get surprised
• Are your children too old for coverage? Dental insurance for your family usually covers children as dependents up to age 18 or 19. If your child is over 18, you should understand when coverage ends and if they are a full-time student, what you must do to prove that for the insurance company.
• Are the services that your dentist is proposing covered? Sometimes, new forms of dental treatment or cosmetic services are not covered by your dental insurance. Be sure to check your benefits guide and/or have your dentist submit a pre-treatment estimate to confirm that the services will be covered. If the services are denied, you or your dentist may need to write a letter and send more explanation regarding the need for these services.
• Do you have coverage from both parents? The dental insurance companies will then use coordination of benefits to determine which insurance is primary and which is secondary for your children. Once you know that, the claim should be submitted to the primary carrier first.
• Does your dentist give a discount for cash? Some offices will allow you to pay and receive a discount for cash and then send in the insurance yourself. This method could save you up to 10% at some offices.
• Does your dentist give a discount for referrals? If you send in your friends and neighbors, will the office give you a break on your bill? Ask what discounts might be available at your dental office to see how you might save more on your bill.

Understanding Your Dental Insurance Plan Options

The market place has provided you multiple options:

• Discount Dental Plans
• Dental Insurance
• DHMO Plans
• Capitation Plans

All of these plans have their pros and cons. Talk with the a dentist you trust to help you make the best choice to maximize your individual dental coverage need.

by Dr. Fred Sharpe

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

My Dental Plan: Maximizing the Benefits of Your Dental Plan

The new dentistry brings together a unique complement of skills, knowledge, and capabilities with one primary focus: ensuring your dental health. Working as a team, your dentist and the dental team he or she has assembled wants to recruit you to join them in making sure this focus on new dentistry is maintained you get full value from your dental health plan.

The dental team has two major parts that you may hear referenced during your visits: the "back" and the "front." These terms refer to two very specific functions of your dental team. The front office handles all the administration, scheduling, dental plans, insurance and financial details, and the back office provides the treatment.

Your front office team makes sure you know about scheduling opportunities, handles finances, files with your dental plans and keeps the administrative details under control to provide you efficient services and support. The back office team is thus free to do what they do best: provide the best care and service for you. You'll find the dentist, dental hygienist, and dental assistant ready to assist you during your appointments.

The key component for success of any team is each member's commitment to do their part. As a consumer and team member, your commitment to new dentistry involves three things:

1. Maintaining your commitment to your dental health through regular hygiene appointments and the daily practice of flossing and brushing.
2. Asking questions and getting the essential information you need about your teeth and gums or to understand any treatment plans.
3. Staying open to options and opportunities that the new dentistry offers you by thinking about the information and feedback that your dentist provides you about the status of your dental health and dental plans.

You can maximize the dental plan benefits with the skills and expertise of your dental team by deciding for yourself what kind of relationship you want with your dentist and the dental team and how they can help you achieve a positive outcome for your dental future.

By Brian DesRoches, PhD

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.