Categories Of Dental Health Insurance

Although many dental plans have individual differences in their features, many fit under several broad categories of care. The most common types of dental insurances offered include the following: Direct Reimbursement Programs: These programs pay the patient back for a predetermined percent of their dental costs. This percentage is repaid regardless of the amount that the treatments cost. This method typically does not exclude coverage based on the types of treatments the patients need. Patients like this program because it allows them to see any dentist of their choice. It’s also generally an economical decision at is forces the patient and dentist work together to the most reasonable solution to keep the patient’s oral health at a premium. “Usual, Customary, & Reasonable (UCR)” Programs: This program allows the patient to select a dentist of their choice in most cases. The URC program will generally pay a set percentage of the fees the patient owes, but they cap the limits of what is paid at what they deem a “reasonable” amount. This policy, whoever, may eliminate some higher-priced dental practices, as the lack of government regulations on the dental industry can lead to a wide variety of different prices that can be charged at different practices for the same procedure. Patients have to do their research and know what the “limits” or “caps” on their plan are, and what the dentist they choose charges to avoid overpaying out-of-pocket costs. Table Or Schedule Of Allowance Program: These programs determine a list of different pre-determined procedures that are covered by the insurance. These programs have a table or schedule that pays a certain preset amount for that procedure, and that stands regardless of what the dentist charges. The rest of the cost is the responsibility of the patient. Capitation Programs: Dental facilities are paid a general, set, fixed amount per patient that is registered to receive treatment at their facility. The dentists in return agree to provide a specific set of treatments to their clients under that cost-per-person per month. These treatments are provided to clients at no cost to the client. The problem with these programs is that sometimes the cost between what the dentist is paid, and what the treatment costs to provide to the client can be massive. The problem with this program is that the dental practices take the loss if it’s too great it can be the end of a dental business. Understanding Dental Insurance Plans: Now that you are familiar with the common types of dental plans offered to most patients, it is also vital to understand the ins and outs of the dental plan. Some things you must consider when getting any dental plans to see if they work for you and your family include: Predetermination Of Costs: It’s vital to know what the costs to you and your family will be out-of-pocket after the insurance company covers what they will pay for. Many insurance companies require you to submit a proposal outline of what types of services will be required, and what the estimated costs of those treatments will be. This is usually drawn up by the dental practice and submitted to the insurance company. Companies then come back with percentages of the treatments they will cover, treatments covered under their plan, and maximums that they will pay out for patient treatments. Many companies will require additional approval for any procedure costing over a certain amount of money. Annual Benefits Limitations: Most insurance plans have a limit or annual cap of what they will pay in benefits per patient each calendar year. However, given that you should be receiving preventative care regularly, this should be an adequate amount to cover your expenses each year unless massive, major problems occur. It is important, however, to know what your budget is and ensure it’s adequate to cover your needs. Peer Review For Dispute Resolutions: Many dental insurance plans set up peer resolution systems between third parties patients, and dental practices. Many costly court cases are avoided, and most disputes are resolved satisfactorily for all involved parties. If you have questions regarding this article please feel free to contact us. www.RamonaDentistryofChino.com 909-465-1016 The Ramona Dentistry Team “Where Family Comes First”