Dental care is crucial to your health, appearance, and wellness. For some, the cost of care is enough to stay away. This increases the danger of serious and expensive dental care in the future. Biannual checkups are very reasonable, less than $100 each, while special dental care is expensive. For many patients a dental plan is the perfect solution. So how do you choose a plan? And, if you have a plan, what does it cover?
Dental plans help you by paying a portion of your dental care. Since most dental plans are through an employer, talk with your provider first. However, here is some information common to all plans that may be helpful.
Who Decides the Treatment?
Decisions regarding treatment involve you and your dentist. If you are an adult, no third party provider (insurance company) can deny treatment. However, depending on your dental plan, not all treatments may be covered. Always consult your dentist and dental plan when researching options.
How Payments are Made
Treatments and payments vary greatly among dental plans. Some states require employers to offer multiple dental plans so employees can choose the best option. If you can choose between several plans, it is best to understand the various styles of coverage.
The most common form of payment is a "Direct Reimbursement" program. The insurance company reimburses you for a portion of your dental expenses. This coverage typically covers treatments and allows you to choose whichever dentist you want.
The next form of payment is "Usual, Customary, and Reasonable.” Similar to Direct Reimbursement, these plans also allow you to see any dentist you want and pay a percentage of the costs. The difference isthat there are limits around "reasonable" or "customary" fees. The downside is "reasonable" and "customary" definitions can vary widely from plan to plan.
A "Table of Allowances" lists the amount your insurance will pay for any procedure listed. Often there is a difference between the Table of Allowances and the actual cost of the treatment. You are then responsible for out-of-pocket expenses with this type of payment plan.
PPOs (Preferred Provider Organization) are plans with dentists who receive lower fees in return for more clients through that plan. You must choose a dentist participating in that dental plan to receive coverage for treatment.
The final type of payment is "Capitation,” or contracts with the dentist to pay a fixed amount per patient or family. In return, the dentist provides specific treatments such as cleanings or fillings. There are usually no charges to you for the specific treatments. However, there may be co-payments required for any other treatments.