Why Have Dental Insurance?
Discount or Referral Plans
Traditional and Indemnity Insurance
Capitation Dental Plans (DHMO's)
What Does My Plan Cover?
Preferred and Exclusive Providers
Get the Most out of Your Insurance
Choosing a Plan
Where Can I get Insurance?
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Traditional and Indemnity Insurance You are in the Driver’s Seat This type of coverage is for individuals or families who want more control over their choice of dentists and services that they need. Traditional Insurance operates on fee for services basis. If little Johnny needs his tooth pulled, it is taken care of and payment is made for that particular service. Traditional and Indemnity Insurance usually have “open panels”. What that means to the purchaser is that they can have their choice of dentist. If you have a family dentist who your children absolutely adore, this is definitely a plus. If you forsee years of dental care ahead for your family, you want to be able to choose a dentist you trust and are comfortable with. Slightly Higher Premiums Your premiums for traditional insurance can be slightly higher than some other plans offer but this is not necessarily a bad thing, depending on the freedom you want in the decision making arena. What is covered will vary as well. Most companies will pay in full for preventive care, such as yearly exams, teeth cleanings, routine x-rays, sealants for kids under eighteen and fluoride treatments. The goal is to prevent dental problems before they start so the company does not have to pay out large amounts for critical care. Payment for other types of dental care can be covered for anywhere from 50% - 80%. Usual, Customary and Reasonable Dental Plan There are two ways your insurance can determine payment for services. One is the Usual, Customary and Reasonable Dental Insurance Plan or UCR, for short. If the company you choose uses this plan, what they will pay is based on a scale from 0 -100% of what dentists normally charge (a UCR fee), most operate on somewhere between 50% - 80%. The insurance company that uses UCR plans will look at what the UCR fees are and what the dentist charges and choose the cheaper of the two. If they go with the dentist fees this is all find and good but if the doctor’s fee is a more than the UCR fee,you may have to make up the difference. For example, let's say that your dental policy states that the insurance company will pay for 80% of the cost of a tooth pulling. Now imagine that your dentist has determined that little Johnny needs a tooth pulled and then performs the treatment. The bill comes to $100. When the dental claim is submitted to the insurance company they will compare your dentist's fee to their "UCR" fee for that same type of procedure. If their UCR data associates a fee of $120 for the type of procedure Johnny received then the insurance company will (quite happily) pay 80% of the cost of the $100 tooth pulling which comes out to $80. You would then need to pay your dentist $20 so to settle the remainder of your bill. If, as an example of the converse, the dental insurance company evaluates their UCR data and finds that it associates a fee of just $90 for the type of procedure your dentist has performed then the insurance company will (to your disappointment) make a payment of only 80% of $90. This comes out to $72. You would then need to pay your dentist $28 to settle your bill. Table of Allowances Dental Insurance Plan The insurance company that calculates payments this way has a Table of Allowances with predetermined payments allowed for various services. You need to ask how often your company updates this in view of inflation. Many companies have not updated their tables in quite some time; therefore the amount allowed is most likely going to be less than what the dentist’s fees will be. Again you may have to pick up the difference if your dentist isn’t willing to take the loss. Things to Know Indemnity insurance can mean higher out of pocket expenses and premiums for your family. This is due to the difference in what dentist charge versus what the insurance company will pay for the procedure. There is usually a yearly deductible as well and most preventive procedures do not come off the deductible. You need to know the annual limit the company will pay per person for treatment. But most of these insurance companies also have a cap on your out of pocket expenses as well. Reasons to Choose Indemnity Insurance There are some strong reasons to choose this type of care. You have choices and this can be a big plus. You usually can choose your dentist and you do not need referrals or authorization to go to a specialist for the care you need. You may need to get pre-approval for certain procedures but it is not nearly as restrictive as dental HMO’s or PPO plans. There is very seldom any type of co-pay for preventative procedures. The goal is to prevent poor dental health so the insurance company encourages routine dental maintenance. This type of insurance is also regulated by state boards so you know it is legitimate. Emergency care or out of town problems are not a problem because you are not restricted to just your dentist. You may have to file your own paperwork in some cases though. feedback@DentalInsuranceLocators.com |
