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You are all too familiar with sticker shock if you've had to pay for braces, root canals or even simple fillings. Find out how to get the most from your insurance plan's dental coverage.
Just like health plans, dental plans vary in design and scope of coverage. There are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and the traditional fee-for-service plans.
Since dental insurance is based on the concept of patient cost-sharing, you have to be an informed consumer to minimize your out-of-pocket costs while maintaining good oral health. To achieve that goal, here are three important steps you can take:
1. Visit a dentist before serious problems develop. Most dental plans promote preventive care by paying for annual or even semi-annual routine dental checkups, which include cleanings and exams. Be sure to take advantage of these visits. A regimen of preventive dental care not only helps you look and feel better, it's the smartest way to spare yourself from the discomfort and expense of complicated dental treatments. You'll find that the more involved the dental procedure, the steeper your co-payments (costs for non-preventive services that you pay). For instance, a typical 20 percent co-payment to have a cavity filled might cost between $12 and $20 depending on what your dentist charges. But a root canal, crown, bridge, or periodontal work (to treat gum disease) can cost upwards of $1,200, and you may be responsible for a 50 percent co-payment.
Since the annual maximum amount that dental plans will pay is frequently in the range of $1,000 to $1,500, you may find yourself running out of benefits altogether if you require a lot of serious dental work. You should also be aware that there are significant co-payments for major services even under most dental HMO plans that advertise lower out-of-pocket costs with no deductible or annual maximum. (When covered, braces are usually provided for under a separate maximum.)
2. Verify what your plan covers before treatment begins. Before you agree to undergo any major dental work, ask your dentist for a detailed description of the treatment you
need and submit it to your insurance carrier to find out how much of the cost they cover. If you feel that your co-payment will be too high, you might ask your dentist if there
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are alternative treatment options that will lower your share of the bill, without jeopardizing your oral health. Sometimes a dentist will agree to do the work for the amount covered by your insurance.
3. Choose a dentist that belongs to your plan's network. With traditional fee-for-service dental plans, you are free to go to any dentist you want. But carefully review the terms of your dental coverage. Most traditional dental plans pay only a percent of what it considers to be a reasonable fee for a treatment procedure regardless of what your dentist charges. You must pay the rest. If your co-payment is going to be high and there isn't a less expensive alternative treatment, or if the dentist won't do the work for the price the insurance company pays, you might have to find another dentist or a clinic or dental teaching facility that has lower rates.
As managed care evolves, the differences between HMOs and PPOs are blurring. Still, it's important to be aware of certain variations. Dental PPOs are becoming increasingly common. This type of plan makes specific fee arrangements with its participating dentists, and your out-of-pocket costs are minimized by selecting a dentist from the PPO's directory. If you pick a dentist who isn't in the PPO's directory, the co-payment for your care goes up by 20 percent or more.
If you enroll in a dental HMO, choosing a non-participating dentist may not even be an option. In such a plan, you usually have to select a dentist under contract with that HMO. If you need a specialist, you will be referred to one who also contracts with the plan. Going outside the plan's network may mean paying the entire bill yourself.
Article presented as printed on www.thehealthpages.com.
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