Dental Insurance Benefits
There are some terms used to describe dental insurance benefits that you need to know. Understanding the legalese that surrounds the insurance industry can go a long way toward helping you choose the right policy.
Preauthorization
This is also known as predetermination of costs. This type of coverage involves having your dentist submit a treatment plan to your provider. Your provider then looks at the proposal and determines what benefits they will allow. This decision is based upon your eligibility, covered services, and the limitations of your dental insurance benefits plan. The intention here is to prioritize and plan your dental treatment and to allocate funding in advance to best match your coverage to cost.
Coordination of Dental Insurance Benefits
If you have dual coverage with a spouse, coordinating benefits maximizes the coverage you get from both dental insurance plans.
Non-duplication of benefits
Some people do not like it when you coordinate benefits. They have a clause in the policy that prohibits overlap if you are covered by two plans.
Annual Dental Insurance Benefits limitations
Insurance companies are for profit organizations and therefore do not want to spend an unlimited amount of money. They place annual limits on the dollar amounts, treatments, and procedures you can receive.
Least expensive alternative treatment (LEAT)
Dental insurance benefits tend to favor the least expensive treatment options. You can always choose a more expensive treatment if you are willing to absorb the difference in cost.
Premium adjustments and Re-evaluations
It is necessary that both you and your employer lobby your insurance company to regularly re-evaluate premium levels. This needs to be done in order to ensure that the UCR or Table of Allowances that the company bases its payouts on are in line with actual fees charged by dentists in your area.
Peer Review for Dispute Resolution
This is a system that exists for resolving the disputes between patients, third parties, and dentists. If a case goes to peer review, your individual records, treatments and results are thoroughly examined before a resolution is recommended. This usually resolves any disputes to the benefit of all parties.
How do third parties categorize the services your dentist provides?
There are basically four service categories your dental insurance benefits plan falls under.
Diagnostic
Diagnostic services refer to exams, x-rays, and other services that are used to evaluate your oral health and detect malfunction or disease.
Preventive
These are services that are intended to prevent decay and disease, such as dental cleanings, fluoride treatments and the application of sealants.
Restorative
When teeth become decayed or damaged, they must be repaired with fillings, crowns, inlays and onlays used to restore strength and functionality.
Discretionary (or elective/cosmetic)
These are treatments that deal primarily with aesthetic concerns and are usually considered optional by the provider.
Preauthorization
This is also known as predetermination of costs. This type of coverage involves having your dentist submit a treatment plan to your provider. Your provider then looks at the proposal and determines what benefits they will allow. This decision is based upon your eligibility, covered services, and the limitations of your dental insurance benefits plan. The intention here is to prioritize and plan your dental treatment and to allocate funding in advance to best match your coverage to cost.
Coordination of Dental Insurance Benefits
If you have dual coverage with a spouse, coordinating benefits maximizes the coverage you get from both dental insurance plans.
Non-duplication of benefits
Some people do not like it when you coordinate benefits. They have a clause in the policy that prohibits overlap if you are covered by two plans.
Annual Dental Insurance Benefits limitations
Insurance companies are for profit organizations and therefore do not want to spend an unlimited amount of money. They place annual limits on the dollar amounts, treatments, and procedures you can receive.
Least expensive alternative treatment (LEAT)
Dental insurance benefits tend to favor the least expensive treatment options. You can always choose a more expensive treatment if you are willing to absorb the difference in cost.
Premium adjustments and Re-evaluations
It is necessary that both you and your employer lobby your insurance company to regularly re-evaluate premium levels. This needs to be done in order to ensure that the UCR or Table of Allowances that the company bases its payouts on are in line with actual fees charged by dentists in your area.
Peer Review for Dispute Resolution
This is a system that exists for resolving the disputes between patients, third parties, and dentists. If a case goes to peer review, your individual records, treatments and results are thoroughly examined before a resolution is recommended. This usually resolves any disputes to the benefit of all parties.
How do third parties categorize the services your dentist provides?
There are basically four service categories your dental insurance benefits plan falls under.
Diagnostic
Diagnostic services refer to exams, x-rays, and other services that are used to evaluate your oral health and detect malfunction or disease.
Preventive
These are services that are intended to prevent decay and disease, such as dental cleanings, fluoride treatments and the application of sealants.
Restorative
When teeth become decayed or damaged, they must be repaired with fillings, crowns, inlays and onlays used to restore strength and functionality.
Discretionary (or elective/cosmetic)
These are treatments that deal primarily with aesthetic concerns and are usually considered optional by the provider.
Labels: dental insurance, dental insurance benefits, dental insurance covers, dental insurance plans
posted by Dental Expert at
12:19 AM
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