Finding a dental plan that works for you is not as difficult as you may think. Here are some questions you should ask before signing up for a plan:
- Will I be able to choose my own dentist? If my dentist is not on the list, will the services my dentist provides be covered?
If you are very particular about who your dentist is, you will want to make sure he accepts your particular insurance plan. If you are more particular about the services you receive rather than which dentist provides them, make sure that is your focal point in your search for a dental plan.
- Does the plan cover diagnostic, preventive and emergency services? Will it cover preventive services such as sealant and fluoride treatments, which may save patients money in the future? Will it provide for full-mouth x-rays? What type of routine dental care is covered? Does the plan cover crowns and bridges, braces, root canals, oral surgery, and treatment of periodontal diseases? What major dental care is covered? Does the plan cover dentures, implants, or treatment for temporomandibular disorders? Who determines the necessary treatment — my dentist or me?
Knowing what your plan covers is very important. If you know you or your child is going to need braces in the near future, you should find a plan that covers it. If you are more concerned about preventive care, find a plan that covers regular checkups. Various cosmetic services such as teeth whitening are also provided on some plans.
- Will the plan allow for referrals to specialists? If so, will the dentist be limited to a list of specialists from which to choose? How does the plan provide for emergency treatment? What provisions are made for emergency care when you are away from home?
Specialized work or emergency services are often not planned for. If you arrange for them in your insurance plan, you will be much more financially prepared for the situation.
Together, both you and your dentist make the decision about treatment. While dental benefits and coverage should be taken into consideration, it should not be the deciding factor in determining your choice of treatment.
There are several types of dental plans that are widely available:
Preferred Provider Organization (PPO) — A network of dentists that have agreed by contract to offer discounted fees to members of the plan
Dental Health Maintenance Organization/ Capitation Plan (DHMO) — Dentists are paid a set fee per enrolled family member per month. The dentists offer routine dental maintenance, which keeps plan members healthier, and therefore are usually the least expensive.
Direct Reimbursement (DR) — This is a self-funded dental benefits plan that keeps track of the actual dollar amount each patients utilizes for dental care. The patient may chose any provider of dental care that he or she wishes, and is not limited to a list. The patient pays the dentist directly at the time of care, and the insurance company reimburses the patient for covered expenses. The American Dental Association recommends this type of plan because there is no monthly fee for members who do not receive the services of a dentist for that month. Because the plan is self-funded, employers are not responsible for influencing treatment decisions of the patient.
When seeking a new or different dental plan, find out all the facts and options that are available to you, so you can find a plan that works for you. If you have a question, do not hesitate to ask the insurance provider to give you the details you desire. After all, it’s your money, and more importantly, your health.
By R. S. Wagner