Dental Insurance May Help You

Understanding Dental Insurance

Dental Insurance and all its derivatives, is used to lessen the out-of-pocket costs of preventive dentistry as well as more significant forms of operative dentistry such as fillings, crowns, root canals, bridges, dentures, extractions, periodontics, other forms of surgery, and even orthodontics. Your insurance company is very much interested in your dental well-being since providing periodic cleanings, exams, and x-rays is a proven method of reducing overall dental treatment and costs.  Insurance companies must make a profit and they want what is best for you, and it is known that prevention is the best avenue to accomplish both.

There is an amazing number of companies which provide dental insurance, whether it be in the form of full dental coverage, PPO’s, DMO’s, or other dental discount plans.  The costs to the patient or to the patient’s employer, vary widely depending upon the coverage purchased.  Full coverage dental insurance, which is an indemnity plan, has a higher cost but allows the patient to choose any dentist they prefer, will usually pay 100% of periodic cleanings, exams, and x-rays, and usually have a maximum of around $2,000 per year in benefits.  A full coverage dental plan is usually associated with a PPO (Preferred Provider Organization, an HMO (Dental Health Maintenance Organization), or other dental discount plans.  PPO’s, HMO’s, and other discount plans usually have a list of dentists from which you must choose.  They may limit the amount they pay for a certain procedure and you must pay the difference.  In some cases, especially with a dental discount plan, the dentist must provide the service at an agreed upon discount rate.

The cost to the patient or the employer for an HMO is usually less than a PPO and the dentist is paid a certain fee per month to provide certain services at no charge to the patient.  This usually consists of cleanings, exams, and x-rays.  For additional services, there is an agreed upon discount fee and the dentist must be listed in the system and the patient may not see any dentist they may choose.  If so the HMO will usually pay nothing and the patient may have to pay the difference in the PPO system.

Most HMO’s have some slight differences in the procedures they cover and the dentist agrees to cover only those services within the plan.  Should the patient elect to go to another dentist outside the plan, the patient must pay for all the services.  Since there is a limited number of dentists within the plan, this sometimes might delay treatment.

Dental discount plans differ from dental insurance plans in that the dentist agrees to charge a discounted fee as his full fee.  It must be remembered that there is a very large number of companies which provide full coverage dental insurance as well as full coverage dental plans, and there is a considerable difference in there coverage.  Usually, there is a deductible associated with a dental insurance plan.  This often is confusing to the patient as they are not familiar with their particular plan and do not realize the difference between a dental discount plan and dental insurance.

In summary, with insurance or indemnity plans, the patient pays the dentist in full and the insurance company reimburses the patient less any yearly deductible.  The dentist will often take assignment of that insurance and only require the patient to pay the difference.  This means the insurance check will go directly to the dentist.  Managed care plans such as PPO’s, DMO’s, and other discount plans cost less, cover less, and the dentist must be in the program and offer a significant discount.  With the PPO plan, if the policy holder elects to use a dentist not within the network, he may do so, but must pay the difference in what the policy pays and what the dentist may charge.  With the DMO plan, there is an even greater discount as the insurance companies prepay the dentist.  In this case, should the patient elect to go outside the network, they will receive no insurance benefit at all.

Today’s Dentist

American Dental Association-Life Member, Fellow of Academy of General Dentistry, American Academy of Implant Dentistry