Dental Insurance Plans
It is essential that you understand your dental insurance plan in order to get a clear picture of the benefits it offers.
The first thing to know is the originator of your plan. There are various sources of dental insurance, all of which operate differently.
1. Insurance companies: Insurance companies are for-profit organizations that assume financial risk of your dental health. They process your claim whenever you have services rendered. Insurance carriers enter into a contract with either groups (normally companies) or with individuals. They offer a variety of benefit packages based upon the specific dental insurance plan.
2. Dental service corporations: These are non-profit organizations that negotiate and coordinate agreements for dental treatment for individuals and patient groups.
3. Self-funded insurers: Some companies will actually reimburse their employees for dental expenses accrued during the time of employment. These reimbursements are typically limited in both dollar amount and treatments covered.
One thing to be on guard about when choosing a new dental insurance plan is whether or not your new policy will allow you to continue to see your regular dentist. It all depends on whether or not you are investing in an open panel plan or a closed panel plan.
An open panel plan will allow you to keep your family dentist, or to choose any other dentist you wish. A closed panel plan will allow you to see only dentists who are on contract with their program.
Two types of closed panel plans exist:
1. PPO (Preferred Provider Organization)- You can choose a dentist in your area who has agreed to charge less than his or her regular fee. If you do not choose a dentist on the list, you have to pay a higher portion of the bill.
2. EPO- (Exclusive Provider Organization): You must choose a dentist from a limited number of professionals who have agreed to charge substantially less for their services. The EPO may even have these professionals on some sort of salary. The majority of dentists do not participate in these plans, so your options here are very limited indeed. Getting to a specialist can be a real challenge in the event you need cosmetic dentistry services or special care. You are also limited in terms of how much care you can receive in a year.
Of course, all dental insurance plans seek to regulate how much dental care you can receive in a year and how much they are willing to pay for that care. Understanding how your benefits and payments are calculated is vital to choosing the right policy.
Usual, customary and reasonable (UCR): These fees are paid directly to the dentist and are based on a schedule that was set decades ago. These fees are quite low compared to normal dental costs. The disadvantage to this is you pay more out of pocket. The advantage is you can see any dentist you wish.
Table or schedule of allowances: This is similar to a UCR but more restrictive. There may be times you cannot choose your own dentist and may not get quality care you prefer. You may also have difficulty finding a specialist. A maximum dollar amount is assigned to each service regardless of regional cost. These fees can vary according to inflation, so be very careful before choosing this plan.
Capitation (also called per capita): This type of dental insurance plan predetermines what level of benefits you will need in a year and agrees to pay for those only. If you get treatment for something outside of the plan, you end up paying for it. The quality of care is often compromised with this plan, because if the dentist is underpaid for his or her services, there may be a temptation to under-treat the condition.
The first thing to know is the originator of your plan. There are various sources of dental insurance, all of which operate differently.
1. Insurance companies: Insurance companies are for-profit organizations that assume financial risk of your dental health. They process your claim whenever you have services rendered. Insurance carriers enter into a contract with either groups (normally companies) or with individuals. They offer a variety of benefit packages based upon the specific dental insurance plan.
2. Dental service corporations: These are non-profit organizations that negotiate and coordinate agreements for dental treatment for individuals and patient groups.
3. Self-funded insurers: Some companies will actually reimburse their employees for dental expenses accrued during the time of employment. These reimbursements are typically limited in both dollar amount and treatments covered.
One thing to be on guard about when choosing a new dental insurance plan is whether or not your new policy will allow you to continue to see your regular dentist. It all depends on whether or not you are investing in an open panel plan or a closed panel plan.
An open panel plan will allow you to keep your family dentist, or to choose any other dentist you wish. A closed panel plan will allow you to see only dentists who are on contract with their program.
Two types of closed panel plans exist:
1. PPO (Preferred Provider Organization)- You can choose a dentist in your area who has agreed to charge less than his or her regular fee. If you do not choose a dentist on the list, you have to pay a higher portion of the bill.
2. EPO- (Exclusive Provider Organization): You must choose a dentist from a limited number of professionals who have agreed to charge substantially less for their services. The EPO may even have these professionals on some sort of salary. The majority of dentists do not participate in these plans, so your options here are very limited indeed. Getting to a specialist can be a real challenge in the event you need cosmetic dentistry services or special care. You are also limited in terms of how much care you can receive in a year.
Of course, all dental insurance plans seek to regulate how much dental care you can receive in a year and how much they are willing to pay for that care. Understanding how your benefits and payments are calculated is vital to choosing the right policy.
Usual, customary and reasonable (UCR): These fees are paid directly to the dentist and are based on a schedule that was set decades ago. These fees are quite low compared to normal dental costs. The disadvantage to this is you pay more out of pocket. The advantage is you can see any dentist you wish.
Table or schedule of allowances: This is similar to a UCR but more restrictive. There may be times you cannot choose your own dentist and may not get quality care you prefer. You may also have difficulty finding a specialist. A maximum dollar amount is assigned to each service regardless of regional cost. These fees can vary according to inflation, so be very careful before choosing this plan.
Capitation (also called per capita): This type of dental insurance plan predetermines what level of benefits you will need in a year and agrees to pay for those only. If you get treatment for something outside of the plan, you end up paying for it. The quality of care is often compromised with this plan, because if the dentist is underpaid for his or her services, there may be a temptation to under-treat the condition.
Labels: dental EPO, dental insurance plans, dental PPO
posted by Dental Expert at
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