People notice a good smile, but people also notice an empty wallet. Many Americans put aside proper dental care because they lack proper insurance. Here are several dental care plans that can turn the frown of out-of-pocket expenses into a dental coverage smile.
Dental Insurance Coverage and Plan Options
- For the individual who prefers the option of selecting their own dentist, the Indemnity Plan is certainly an option. With this plan a person pays a flat fee for their dental visit, but they have an annual limit for spending coverage.
- In a similar fashion as the Indemnity Plan, the Self-Insurance Plan allows an individual the same payment and coverage options, but the person may not be able to choose their own dentist.
- The Closed Panel Plan restricts an individual to the number of dentists and facilities available. On the surface this coverage is designed for those who are not picky or specific about certain dentists or locations, etc.
- If a person is looking for coverage based on intervals of treatment and care, the Capitation Plan is an option. Under this coverage, the dentist will have a contract stating they will be compensated based on intervals of visits even if no treatment is actually required.
- The PPO plan (Preferred Provider Organization)is insurance coverage which allows people to receive dental care via cost reduction.
Special Dental Procedures
Once an individual has found the dental plan that is right for them, it's important to know what is and what is not covered. Certain fillings requiring composite materials may not be fully covered. Also, cosmetic dental surgery is not usually covered by an insurance plan. Routine procedures (basic fillings, root canals, etc) may be covered in the cosmetic procedure, but anything related to restoration such as porcelain veneers may not be covered. However, it is important to consult with your dentist and ask about the possibility of reimbursement.
As a path of least regret, consult with the finance department and understand the costs for dental treatment prior to receiving dental care. Understand how much the insurance will cover, and whether or not any out-of-pockets expenses will be included in a given dental procedure.
How to Determine Out-of-Pocket Expenses
Dental insurance companies use UCR (Usual, Customary and Reasonable) as a way for insurance providers to determine the necessary fees based on dental procedures. Using this method, an individual can determine the out-of-pocket expense based on a given procedure. If the UCR dollar amount is UNDER the amount specified for the actual procedure, the individual must pay the difference.
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