Category: Blog

When you are reviewing and comparing dental plans its paramount that you choose a plan that properly fits your needs. Different plans cover different things. All dental insurance programs have strengths and weaknesses, but it’s a question of what makes the most sense to meet the needs of you and your family. Most plans depend on the cost of your dental care each year, the problems/issues members in the family have treated, and how much each insurance plan will cost. The idea is to have the lowest possible out-of-pocket payments while receiving the best care you deserve. Virtually all dental insurance plans have some limit on what they will pay per patient, but he idea is getting the most of that plan based on you needs. That helps you know what to look for.
The first and main criteria when selecting a dentist is the question if the dental insurance limits the dentists you can choose to see. If so, it’s important to see if your dentist of choice is on that list. It’s also important to know who controls the cost of treatment. Some plans let you and your dentist choose what is best for you, and others require your dentist to follow the “cheapest possible option” approach, even when those approaches are not in the patient’s best interest, or do not fix the problem long-term.
It’s also important to ensure that the plans cover preventative treatment costs and care such as regular screenings, x-rays, and cleanings. Having preventative treatment done can help save a lot of pain and suffering, as well as expense in the future. If the plan does cover preventative care (MOST do), it is also important to be aware of how much of that cost is covered by insurance and how much will be your responsibility. Knowing this key information can help you determine estimates of your out-of-pocket costs.
Most dental plans have some limits of how much the plan will pay in benefits per calendar year for each patient. Know what the limit is, because the rest is likely out-of-pocket costs to you. It’s also important to know if the plan covers referrals to specialists in the dental field for work that is not able to be done by your traditional dentist. This is vital if major oral procedures are needed, or concerns about oral health arise. Finally, it is vital to see if this coverage just covers you, or if it includes everyone in your family. Knowing your whole family is covered is important to knowing what out-of-pocket costs you will incur.
For more information on these specifics, ask your dentist for more information. If they do now know the information to these basics off-hand, they may not be a great choice for an oral health care provider.
Limitations Of Dental Insurance Plans:


Virtually all dental insurance plans will have limits as to how many benefits each person or individual can claim per year. Sometimes insurance plans will also provide a cost-sharing program that allows the cost to be shared among family members, but those plans are also generally capped at a certain value. This is how insurance plans control costs. The rest of the expenses of dental treatment beyond that cap limit are likely covered out of your pocket. It’s also worth noting that all plans exclude experimental treatments that are not proven to work, and those procedures not approved by the government. Those will be out-of-pocket costs. Also check with your medical insurances, as some plans may cover costs dental insurances won’t to save you paying out-of-pocket unnecessarily.
Points To Consider About Dental Insurance:
When choosing a dental plan, it’s important to work with the plan purchasers to regularly review that the UCR or Table Of Allowances payment schedules are equitable. This keeps costs affordable while optimizing benefit levels to ensure every dollar the patient spends works to its full capacity.
It’s vital that the patient notifies the administrator of your main insurance provider if you are covered under more than one insurance plan. Insurance plan benefits coordination will help protect your rights and ensure you receive the maximum benefits you are entitled to. Insurance coverages may overlap to provide full coverage if the main insurance policy doesn’t cover everything.
Odd as it sounds, it’s actually wise in most cases to choose an insurance plan with a financial limit to it. Many other insurance plans will exclude entire categories of services. If you need one of those services you will likely pay a lot more for that procedure than you would paying overflow costs from a plan that covers a percentage of all procedures.
If you have issues with what you are being charged, the good news is that most insurance plans offer services to help dispute any charges you may question to help settle costs. It’s much cheaper than court costs, and helps stretch every dollar to go to patient services.

If you have any questions regarding this topic feel free to contact us and/or call us 909-465-1016

The Ramona Dentistry Team
“Where Family Comes First”

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”

1. Know What Benefits You Get. Oftentimes, people will choose their dentists based on their dental healthcare plans. Some healthcare plans can limit which dentists you can see, or the plan will not pay for the care. Be sure to do your research, and know which dentists and treatments are covered under the plan you have. If you are not sure, call the dentist you want to see, or call your insurance company for more information about what your plan covers. Also, make sure you know your options for what treatments are covered to avoid paying any extra fees that might otherwise be avoided, and which treatments have the lowest copays and premiums associated with them.
2. Ask Around For Recommendations. Once you know the dentists covered under your insurance plan ask around to friends and family in the local area who may see or have seen this specific dentist. Find out what your best options are before committing to a specific doctor. If you don’t know anyone who has seen these dentists, ask your physician or current dentist (if they are someone different) for recommendations. Do your research before committing to a specific practice. Then check to see if that dentist is a member of national-level organizations to ensure they provide quality care to their clients. Agencies such as the American Dental Association (ADA), Academy of General Dentistry (AGD), or local dentistry society such as the California Dental Association (CDA) are some to look for.
3. Factor In Accessibility. It’s important to consider how convenient the location of the dentist is to your daily life. Is the office easy to get to from home or work? Are the office hours fitting with your schedule? If you cannot easily make an appointment and get it the office location weigh the options of seeing some other dentists covered under your medical plan.
4. Meet The Dentist For A Consultation Before Scheduling An Appointment. Before you schedule your appointment, request to meet with the dentist so you can know more of what to expect and what kind of care they seem they will provide. Make a list of questions you would like to ask the dentist, and list of things that are important to you. Ask how they will handle any discomfort or phobias you may encounter during treatment. If you don’t feel comfortable during the first consultation, that dentist probably is not a good fit for you. It’s time to move on to someone who seems a better fit.
5. Evaluate The Dentist After The First Appointment. During your initial visit, be extra-alert to your surroundings. How clean is the office? Is the equipment sterile (remember that is going in your mouth!)? How professional and courteous is the staff? How comfortable do you feel with the hygienist and dentist that are providing care? It ultimately determines to help if you will be willing to continue to use this provider, and if you will go back again.

These are just some guidelines to help you choose a dentist that is an appropriate fit for you. Ultimately, it comes down to what your insurance covers, as well as which dentist is the right fit for you and your family. Remember, ask questions: medical professionals, including dentists, are there to serve you and your family!

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”