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Dental Insurance

We know dental insurance is a complicated matter, and picking the best one for you can be overwhelming, to say the least. Here are the most often questions we hear from patients and our advice to help make the process a little less of a headache!

  1. What should I look for when purchasing a dental insurance plan?

  • Premiums vs. Maximum

If you choose an insurance premium that pays $1000 for a calendar year but your premiums are more or slightly less, it may not be cost effective to purchase that particular plan.

  • Waiting Periods

When you first purchase some plans, there will be a waiting period before you can have certain procedures performed. This means you have to pay a full 12 months of premiums to the insurance company prior to them releasing funds for your treatment procedures.

  • HMO vs. PPO

HMO, or Health Maintenance Organization, allows access to only certain providers. These providers then “manage” your care. My opinion, HMO’s for dentistry are not a great option. They don’t allow you to see who you want to see, then it’s up to that provider to “manage” your care. The provider typically gets paid per patient, instead of procedures. The incentive is to do less.

PPO’s, or Preferred Provider Organization, allow you to pick the doctor you want. PPO’s typically also have fewer restrictions on treatment and on seeing non-network providers.  My opinion, while PPO’s may cost slightly more, it’s worth it. PPO’s offer better flexibility to your care, you are not required to see only a select number of doctors, and treatment is paid based on need, not because you are just a patient.

  1. What is the difference between in and out of network benefits?

Insurance is always a contract between your employer, you and your insurance company.  The insurance company sets their own fees for services based on an average. If the insurance company sets the fees lower than the treating dentist, the patient will be responsible for the balance. If the dentist is in the network of the insurance company, then the fees will be adjusted to the set fee schedules of the insurance company. However, on many occasions there is little or no difference. Out of network providers do not negotiate fees.

  1. What is covered under my dental plan?

Most dental insurance plans will provide you with a minimum of two regular dental check-ups and dental cleanings per year. Insurance will help with some of the cost on other services such as fillings, periodontal treatment or crowns. Each insurance group has difference policies when it comes to paying for dental treatment. For example, some insurance companies do not cover tooth colored fillings on posterior teeth, some insurance companies do not cover implants and some insurance companies may not cover tooth replacement.

The bottom line – There are thousands of different insurance carriers and groups within each carrier. It is impossible to know what each group and plan covers for each patient, so we always recommend our patients call their insurance provider to confirm what it and is not covered under their plan.  If you ever have questions about your insurance, fill out this form and give us a call to go over any questions you have.

For further information about dental insurance check out the ADA site.