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Know About a Dental Plan Before You Buy Insurance Coverage

Everyone seems to want a dental plan, but many dental patients don’t fully understand what it can do for them. The following information is intended to provide an overview of dental insurance, the variations that exist and how to effectively use your dental plan coverage and benefits. Also be sure to ask your employer if they have a discount dental plan.

Dental insurance is most commonly found as an employee benefit that helps the member and his or her family to afford proper dental care services. While dental insurance plans for individuals are sold, they are often quite expensive due to the elective nature of most dental services. Employers and their human resource managers purchase most dental plans for the company’s employees.

Dental plan and medical insurance programs are quite different in their coverage and their philosophy. A dental insurance plan is designed to support preventive care the helps the patient to avoid major dental expenses, while medical insurance programs are designed to provide extensive coverage for major illness and diseases, but little or no coverage for preventive services.

A similar medical insurance plan would have nearly complete coverage for preventive and diagnostic services, but lower coverage for a life-threatening illness that kept the patient in the hospital for an extended period of time.

The coverage levels in a dental plan are generally expressed as a series of three numbers, for instance - 100 / 80 / 50 - which represents the percentages of coverage for Preventive and Diagnostic services, Basic Restorative services (simple fillings) and Major Services (crowns, bridges and dentures). For a significant dental treatment plan, the majority of the cost will be borne by the patient because of the 50% coverage and annual maximum benefits that may be as low as $1500. Be sure to look for affordable discount dental plans.

The method of payment for dental insurance plans is referred to as fee-for-service. That is, the dentist charges a separate fee for each service rendered and the charges are submitted to the insurance company on a claim. Traditionally, those claims were paper claims that were mailed to the insurance company, but today many of the claims are being sent electronically from the dentist’s computer to the insurance company’s computer and then paid electronically back to the dentist.

It is important to remember that dental services are nearly always elective. Most patients do not have any life-threatening dental issues. Despite the fact that dental disease can be painful, the risk of death or serious consequences from a dental problem is very low. While the pain could make the situation very urgent for the patient, once the pain is relieved, the subsequent treatment can be performed quickly or slowly depending upon the expectations of the patient and the availability of the dentist and your dental plan coverage.

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.

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.