Even though most people consider medical insurance a necessity, many don’t feel the same way about dental insurance or they don’t think about it at all. That can be a mistake, especially when something happens that requires a dental procedure that goes beyond routine dental cleaning and yearly checkups.
Differences Between Medical and Dental Plans
There are distinct differences between medical health insurance and dental insurance plans. Most standard health insurance does not cover dental services, making it important to understand the benefits when signing up for insurance through your employer or with a private insurer. In addition, even if you have a dental insurance plan, many times it will not pay for 100 percent of all services. There are other specific variations as well, including the fact that current oral health is not usually a deterrent to obtaining insurance, although is a yearly dollar limits attached to a dental plan. In all cases, it is wise to be aware of covered procedures and the co-pay requirements prior to your need for treatment.
Types of Plans
Dental insurance plans usually fall into one of the following categories:
Usual, Customary and Reasonable: These plans are commonly referred to as UCR insurance and may have few restrictions. They pay a set and sometimes percentage amount for specific services. There is little regulation, and the reimbursable dollar amounts may not be adequate for the “usual” fees charged in your geographical area. UCR plans vary greatly, and there is no government regulation.
Direct Reimbursement Programs generally pay a set percentage of total fees, but they usually expect you to pay the dentist and then submit a claim for reimbursement. They typically have few limitations on type or dollar amounts, and allow free choice in terms of choosing a dental professional who is contracted with this plan.
Scheduled Allowance Plans have a published list of procedures that are covered with corresponding dollar limitations. You are free to choose your dentist who is contracted with the plan, but this insurance will pay on a fee schedule, regardless of the actual charge. In all cases, you are expected to pay the difference.
Capitation programs involve a contract between the insurance carrier and participating dentists. Specific services may be covered in full, or a co-payment might be required, but services are not billed individually. Again, typically only certain procedures are included in the plan, so it pays to be fully aware of your options. Also, it may be difficult to find a dental professional in your area, and specialists may not be available when needed.
Why Dental Care Is Important
There is increasing medical evidence that oral health can affect overall health, and that the condition of your gums and teeth may be an early warning system for other diseases and medical conditions. While it is relatively easy to prevent tooth and gum problems with regular care, it can also be easy to neglect your teeth if you have no serious problems. Unfortunately, when you neglect your teeth over a period of time, the potential for problems increases. And that can be a serious problem.
Children and older citizens who don’t have regular dental checkups are at risk not only for cavities that can lead to gum disease and lost teeth, but are prone to problems with staining, crooked teeth and other oral health problems that affect appearance as well as function.
Know your Plan’s Provisions
Because dental insurance is not as common, or as regulated, as medical insurance, it is important that you fully understand the specific provisions of any dental plan you consider. If you have health insurance through an employer, ask if there is any dental coverage for emergencies such as accidental injury or an emergency extraction. In some cases, there might be overlapping coverage.
Many dental plans exclude certain procedures, or place yearly limits on number of visits or on coverage, perhaps a $1,300 cap on services for each family member. Other plans require the dentist to submit a predetermination plan for approval prior to beginning any dental restoration or cosmetic treatment. You will want to determine the need for advance approval, if that is required by your plan.
Don’t Neglect Your Smile
At Briglia Dental Group, we are committed to working with our patients to not only ensure oral health, but to enhance your smile in every way possible. Not only will we work with you if you currently have dental insurance coverage, but we have also developed an Oral Health Savings Plan, designed specifically for our patients who do not have a plan in effect. Most insurance plans have not kept pace with the rising costs of dental care. We think you’ll be pleasantly surprised by the thoughtful benefits of our “savings plan.”
We recognize that many families find it increasingly difficult to manage higher costs of health care and dental procedures; we also know how vital it is to protect your teeth and encourage quality oral health care throughout life. Won’t you schedule an appointment to discuss the options for care that we provide? For over 30 years, we have given local families a reason to smile. Let us do the same for you and for your entire family. Give us a call at 610-692-4440 or fill out an appointment request online. We look forward to hearing from you.