You have been kicked off your parents plan, or are branching out on your own and you know you need individual dental insurance. Individual dental insurance is comparable to family dental insurance with benefits and limitations. All dental plans are limited in terms of what they can help you with. The following is a list of common limitations you can expect:
• Limits the amount of benefits they will pay per patient per year.
• Individual dental insurance will typically exclude certain treatments or services
• Exclude experimental procedures
• The procedures must be performed under the supervision of a dentist
When looking for individual dental insurance, always ask what is included or excluded. There is a list of administrative extras to maximize your individual dental insurance benefits. Predetermination of costs is when you and your dentist together are expected to submit a treatment proposal to the plan administrator before receiving treatment.
They do this so they can review your eligibility, the length of time you will be covered, services offered, your required co-payment, and what the maximum limitation is on individual dental insurance. Some individual dental insurance plans require predetermination for treatment greater than a specified dollar total. This procedure is represented in a few different terms: preauthorization, precertification, pretreatment review or prior authorization. This predetermination helps you plan with your dentist which treatments are needed for your oral health needs.
One way to save money on your individual dental insurance is to limit your benefits by number of procedures and/or a dollar amount in a certain year. If you have regularly received preventative care, the limitations you decide on will not affect you because your oral care is in good health. This allows you to save money on coverage. By planning in advance, you can minimize the expenses you pay and maximize compensation offered by your individual dental insurance benefits plan.
If there becomes a problem with your plan or the services rendered, many individual dental plans offer dispute resolution through a procedure known as peer review. This eliminates costly court cases. It is also established to provide you with fairness in your individual dental insurance because of a careful assessment of records, treatment procedures and results. Most of the disputes are resolved in an acceptable method for all parties concerned.
As a patient and purchaser of your individual dental insurance, insist on regular reviews of premium levels to make sure the UCR or table of allowances payment schedules are equitable. This will help you to optimize the benefits, making sure your money is spent wisely. Last, but not least, is coordination of benefits. If you are covered under two individual dental insurance benefits plans, let the administrator know of your dual coverage status. By coordinating the individual dental insurance benefits, it can help you protect your rights and maximize your entitled benefits. There will be some cases where you will be guaranteed full coverage because the benefits from both plans overlap.
As you search for the right individual dental insurance plan, hopefully this information can help you in knowing what the best course of action is for you! Check with your dentist for help in knowing which benefits you need for your oral care and what individual dental insurance providers he or she would recommend.
By: Emily Thomas