Dental insurance plans are variable with both features and cost. It is important for an individual to know what their particular plan offers as this will determine what is covered and what must be paid out of pocket. The following outlines the most common categories of dental insurance.
This type of plan is a popular choice because it is based on a predetermined percentage of the total treatment cost. Typically, direct reimbursement does not exclude methods of treatment and offers patients the freedom of choosing their own dentist. It also aids the patient in choosing the most economical solution to preserve their oral health.
Usual, Customary and Reasonable
Also known as a UCR, this plan allows the patient to visit a dentist of their choice and pay the reasonable or customary limit of the fees. The limits are set in the contract between the patient and the third-party payer. While the limits are referred to as customary, they may not be what a dentist will actually charge the patient. The drawback to this plan is a lack of federal regulation in regard to the level of fees.
Table of Schedule of Allowance
This program provides a list of services that are covered and the cost limit that will be paid. The limits may be less than what the dentist charges, and the difference must be paid for by the patient.
In this case, the dentist is paid a fixed amount of money each month for every individual that is enrolled in the program. In exchange, the dentist will perform treatment at no charge to the patients, although there may be a co-payment in some circumstances. In addition, the premium paid by the individual or family can be different than what the plan pays out for dental care.
All patients should request a review of premium levels at regular intervals to ensure that the plan’s money is being spent in the best manner. Those who have more than one dental insurance plan should inform each carrier of this status to protect rights and benefits. This will ensure that benefits are provided by one plan when another one excludes a particular treatment. Selecting a policy that has service or dollar limitations is often wiser than choosing one that excludes treatment categories. This allows the patient to develop the best plan and receive the right care from their dentist. The patient should also see if the plan provides tools for budgeting, analysis and the dispute of dental care costs.
Buying dental insurance is an important step in overall health care. Using the list above as a guideline will lead patients to the plan that is right for their needs, but be sure to call us to ask about your specific dental insurance plan.
Also take a look at our page on some of the most common dental procedures.