The Ins and Outs of Dental Insurance

Investing in good oral health by electing to participate in a dental insurance program is a great first step toward health and well-being. But, if you are like many patients, navigating the peculiarities and technicalities of available coverage is enough to make you grind your teeth at night!

A Word About Dental Insurance
According to data gathered by the U.S. Department of Labor’s Bureau of Labor Statistics, the cost of dental treatment has risen significantly less than the cost of medical treatment in recent decades. The structure of a dental plan differs greatly from that of a medical plan, largely because dental needs and treatments are predictable, lower-cost, and non-catastrophic compared to medical needs and treatments.

Additionally, dental disease is most often preventable and coverage is often provided for preventative exams and treatments. Exams and X-rays in the dental industry are typically lower-cost than medical exams and diagnostic procedures. More importantly, if decay or disease is present, early detection is the key to a less expensive treatment.

Get to Know Your Dental Plan
Hope Perry, office manager of McLean County Dental in Bloomington shares, “Of the hundreds of dental plans that are available within the area, no two plans are alike.” She shares these tips for patients to consider before visiting their dental office.

  • Know your plan name and insurance provider. If you have an insurance card, bring it to the dental appointment.  If not, be certain to know the name of the insurance provider company. If you are uncertain, contact a Human Resources representative within your company.
  • Know what type of plan you have. Dental insurance plans are generally Preferred Provider Organizations (PPO), Health Maintenance Organization (HMO), Dental Maintenance Organizations (DMO), or Dental Plan Organizations (DPO). This information is important because dentists participate in many different types of plans, and coverages and limitations to vary.
  • Be familiar with coverage percentages. Preventative care for things like cleanings, exams, sealants, X-rays, and fluoride treatments are often covered at a higher percentage than major items like crowns, inlays, dentures, and implants.
  • Know your limits. Two things come to mind here, deductibles and maximum plan benefits. A deductible is the amount of money a patient must pay before insurance kicks in, usually $50 per person and $150 per family. A maximum plan benefit is the amount of benefit provided up to a certain dollar amount. For instance, if the maximum plan benefit is $1,000 per person and $2,000 per family, once the maximum is reached for a plan year, any remaining dental treatment, including preventive care, must be paid out-of-pocket.
  • Keeping It All Straight
    Considering the list previously mentioned might give you a toothache, do not worry, help with understanding the plan is available. “I consider it part of my job to help patients understand their dental plans,” says Perry. “I want to help each patient make the most of their insurance.”

Plans differ greatly by available coverages, limitations, frequencies, deductible amounts, and participating providers. “It is possible that not all treatment desired or needed, will be covered by the patient’s dental plan,” says Perry. “That is why building and maintaining a relationship with patients and their insurance providers is essential. We are knowledgeable about the majority of plans within the area. But if we encounter a new plan, we work with the provider to quickly understand the requirements and available coverage.”

Insurance Isn’t the Only Factor
It’s easy to slip into the pitfall of basing oral health decisions on what is allowable within a dental insurance plan, but there are some dangers with doing this. If a dentist or dental hygienist is suggesting treatment, it is likely because the recommendation is what the patient needs, regardless of the insurance plan. A pre-treatment estimate will help determine what will and won’t be covered by insurance. Understanding the patient portion, and payment provisions (aka, the ins and outs of the plan) will help manage a budget, and with a little help from the office staff, you’ll have something to smile about.

Hope Perry is the office manager for Dr. Emil Verban and his team of hygienists and assistants at McLean County Dental. Their office offers a wide range of services including preventive and routine care, implants, root canals, and extractions. Contact them at 309-662-8448.

Originally published at Health Cells Magazine.

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