Dental insurance, what the insurance companies didn't tell you.

What is dental insurance? Dental insurance covers the patient against dental costs. It isnot uncommon to have a dental insurance or dental plan togetherwith your health insurance. Some employer will offer some formof dental insurance over and above the company medical insurance.Unlike health insurance that covers diagnosing, treating andcuring serious illnesses, dental insurance mostly coverspreventive treatment. Dental treatment is highly predictable andvery often non-catastrophic. Most dentists will advise patientsto have at least one check-up every six months, that kind ofpreventive treatment is covered by most good dental insurances.Dental plans very often encourage patients to have regulardental check and promote good dental hygiene, it is in therebest interest to offer such plans with the dental insurance. Do i need dental insurance? As mentioned, unlike health insurance, dental insurance is verypredictable and as such is not always a good candidate forinsurance. For example, most dental insurance will offer $1000.00 cover peryear, but the fact is that most patients never require more than$100.00 per year. Self funding might be a better option as itremoves the dental insurance overheads.The employer optionBut if something goes wrong then you might need a comprehensivedental insurance cover or access to funds that you might nothave.This is why some employers offer Direct Reimbursement (D.R.),the employer takes a percentage of salary into a dentalinsurance fund and this covers the employees. The insurance companies responseTo offer cheaper dental insurances than the one offered byemployers, insurance companies responded with HMO's andPreferred Provider Plans (PPO's). Under those plans theinsurance can offer cheaper premiums, but the treatments offeredare often very limited. Another problem is that the dentistsoften increase the waiting lists and limit specialisttreatments. The common options Although the employer dental insurance is often the betteroption you need to look at that they actually offer you.Who will select the dentist? --Open Panel, you choose the dentist without any restrictions.--Close Panel, you are given a list of dentist to select, theyin turn signed an agreement controlling their charges with thedental insurance company.--Preferred Provider Organization (PPO), Group of dentist thatoffer to charge less, if you want someone else, you might needto pay the difference.--Exclusive Provider Organization (EPO), Group of dentist thatoffer to charge a lot less, but then the client cannot goanywhere else, (unless they pay the full price).As you can see the more you go down the list the morerestrictive the options are, typically an Self-Funded Insurerswill offer an open panel whereas Dental Service Corporations andInsurance Carriers will offer EPO's.How is the dentist compensated? --Payment plan, the patient pays a monthly fee to the insurerand in turn the insurer pays the dentists/specialist.--Capitation Plans, the dentists charges the insurance company acertain amount per-capita, (per patient), and in turn offer totreat the patient.--Direct Reimbursement Plans, the patient pays the full priceand the dental insurance plan will reimburse all or some of themoney.The second option is very limiting as some rogue dentists areinclined to offer substandard treatment to maximise theirprofit. The last option allows you to choose the best treatmentplan.All above can limit the percent value that is actually beenrepayed and/or cap the yearly value that can be (re-)claimed. How are the benefits and payments calculated? --A list is given of what is covered and for how much, anyamounts over are not reimbursed by the dental insurance.--The dental insurance offers a maximum amount that can bereimbursed per year, as long as the patient is within thatfigure the insurance will cover them. This is great for longterm treatments, allowing the patient to choose the best valuefor money and overall treatment for their need.What ever cover is offered by the dental insurance you must makesure that it has a regular review to ensure that the benefitsare fair and reasonable. Find out more about dentalinsurance