Dental Insurance, What the Insurance Companies Didn’t Tell You

What is dental insurance?

Dental insurance covers the patient against dental costs. It is not uncommon to have a dental insurance or dental plan together with your health insurance. Some employer will offer some form of dental insurance over and above the company medical insurance.

Unlike health insurance that covers diagnosing, treating and curing serious illnesses, dental insurance mostly covers preventive treatment. Dental treatment is highly predictable and very often non-catastrophic. Most dentists will advise patients to have at least one check-up every six months, that kind of preventive treatment is covered by most good dental insurances.

Dental plans very often encourage patients to have regular dental check and promote good dental hygiene, it is in there best interest to offer such plans with the dental insurance.

Do i need dental insurance?

As mentioned, unlike health insurance, dental insurance is very predictable and as such is not always a good candidate for insurance.

For example, most dental insurance will offer $1000.00 cover per year, but the fact is that most patients never require more than $100.00 per year. Self funding might be a better option as it removes the dental insurance overheads.

The employer option

But if something goes wrong then you might need a comprehensive dental insurance cover or access to funds that you might not have.

This is why some employers offer Direct Reimbursement (D.R.), the employer takes a percentage of salary into a dental insurance fund and this covers the employees.

The insurance companies response

To offer cheaper dental insurances than the one offered by employers, insurance companies responded with HMO’s and Preferred Provider Plans (PPO’s). Under those plans the insurance can offer cheaper premiums, but the treatments offered are often very limited. Another problem is that the dentists often increase the waiting lists and limit specialist treatments.

The common options

Although the employer dental insurance is often the better option you need to look at that they actually offer you.

Who will select the dentist?

  • Open Panel, you choose the dentist without any restrictions.
  • Close Panel, you are given a list of dentist to select, they in turn signed an agreement controlling their charges with the dental insurance company.
  • Preferred Provider Organization (PPO), Group of dentist that offer to charge less, if you want someone else, you might need to pay the difference.
  • Exclusive Provider Organization (EPO), Group of dentist that offer to charge a lot less, but then the client cannot go anywhere else, (unless they pay the full price).

As you can see the more you go down the list the more restrictive the options are, typically an Self-Funded Insurers will offer an open panel whereas Dental Service Corporations and Insurance Carriers will offer EPO’s.

How is the dentist compensated?

  • Payment plan, the patient pays a monthly fee to the insurer and in turn the insurer pays the dentists/specialist.
  • Capitation Plans, the dentists charges the insurance company a certain amount per-capita, (per patient), and in turn offer to treat the patient.
  • Direct Reimbursement Plans, the patient pays the full price and the dental insurance plan will reimburse all or some of the money.

The second option is very limiting as some rogue dentists are inclined to offer substandard treatment to maximise their profit. The last option allows you to choose the best treatment plan.

All above can limit the percent value that is actually been repayed and/or cap the yearly value that can be (re-)claimed.

How are the benefits and payments calculated?

  • A list is given of what is covered and for how much, any amounts over are not reimbursed by the dental insurance.
  • The dental insurance offers a maximum amount that can be reimbursed per year, as long as the patient is within that figure the insurance will cover them. This is great for long term treatments, allowing the patient to choose the best value for money and overall treatment for their need.

What ever cover is offered by the dental insurance you must make sure that it has a regular review to ensure that the benefits are fair and reasonable.

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