It is vitally important to understand what your dental insurance plan covers so that you may get a clear picture of the benefits it offers.

It is also very important that you know who the originator of your plan is.  There are many sources of dental insurance, all of which work differently. 

1.       Insurance companies

Insurance companies are commercial organizations that assume the financial risk of your dental care and any procedures that care may entail. Insurance companies enter into a contract, called an insurance policy, either with groups (usually companies), or with individuals.  They offer a variety of benefit packages based upon a particular dental insurance plan.  When you receive treatment from your dentists, your insurance company processes your claim and pays the agreed upon portion of your service fees.

2.       Dental service corporations:

These are not-for-profit organizations that negotiate and coordinate agreements for dental treatment.  They offer services to both qualified individuals and patient groups.

3.       Self-funded insurers:

Some employers act as insurers of their individual employees.  They reimburse their workers for dental expenses accrued during the time of employment.  These reimbursements are typically limited in terms of what treatment is covered and what dollar amount is reimbursed according to that treatment.

One thing to be aware of when you choose a new dental insurance plan is whether or not the new policy will allow you to continue to see the dentist of your choice.  This will depend on whether or not you are choosing an open-panel plan or a closed-panel plan. 

Open-panel plans allow patients to keep their dentists of choice.  Closed-panel plans require patients to see dentists who are on a list. 

To clarify even further, please understand that there are two types of closed panel plans: 

1.       PPO (Preferred Provider Organization)- A PPO allows the patient to choose a dentist in the area who has agreed to charge less than his or her regular fee.  If the patient does not choose a dentist on the list, he or she will have to pay a higher portion of the bill.

2.       EPO- (Exclusive Provider Organization): The patient must choose a dentist from a limited number of professionals that have agreed to charge substantially less for dental services.  The EPO may even pay a salary of sorts to these dentists.  Most dentists do not like to work with these plans, so patient options tend to be limited.  Finding a specialist can be difficult in the event a person needs cosmetic dentistry services or special treatment.  People are also limited in terms of how much care they can receive per annum.

Of course, all dental insurance plans always look to regulate how much dental care you will receive in a year, and how much they are willing to pay for that care.  Understanding the many benefits they offer and how these payments are calculated is essential to choosing the right policy. 

Usual, Customary and Reasonable (UCR):

This term refers to how fees are paid directly to the dentist, and it refers to a fee schedule that was established decades ago.  These fees are rather low compared to normal dental costs.  The disadvantage her is that the patient pays more out of pocket.  The advantage to the patient is freedom of choice in seeing whatever dentist is preferred. 

Table or schedule of allowances:

This is similar to a UCR but more restrictive.  There may be instances where the patient cannot choose their own dentist and may not get the quality care they prefer.  They may also have difficulty finding a specialist.  A maximum dollar amount is assigned to every service regardless of regional cost.  These fees often vary according to inflation, so people need to be very careful before choosing this type of plan. 

Capitation (also called per capita):

This type of dental insurance plan predetermines what level of benefits a patient will require in one year and agrees to pay for those only.  If the patient receives treatment for something outside of the plan, he or she ends up paying for it.  The quality of care is often compromised with this plan, because if a dentist is underpaid for his or her services, there may be a temptation to under-treat the condition.

If you are looking to improve your smile without diminishing it with visible orthodontics in the process, please call us at 1-888-790-0309 to schedule an appointment for this highly specialized and technologically advanced alternative to metal braces.