Dental Insurance Plan
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Dental insurance plans are basically agreements between the employer and the insurance company. Most plans offered by dental insurance companies allow for part reimbursement of dental treatment expenses. Many plans also discourage certain kind of treatments or allow access to certain of dentists. To consider these points one has to go through the plan very carefully with a toothcomb. For example choosing a dentist is not same as choosing a dentist from “the list”, or if the plan does not cover one kind of treatment, it is wrong to infer that your regular dentist is incompetent.
Many plans do not cover pre existing conditions. Some may not cover implants and so on. Due to these preconditions, the final treatment may be paid for in part only or in insurance parlance you might be reimbursed for LEAT (Lease Expensive Alternative Treatment). Dental insurance plans vary in fixing the UCR (usual, customary, and reasonable) in a certain geographical area. UCR may vary from plan to plan and company to company despite operating in the same area. Therefore fixation of this UCR level would define the liability of the patient. In some plans the patient may have to pay more and in some he may have to pay less depends upon the plan the employer has offered.
An employee has to ask himself the following before he finalizes on a plan:
Would the employees like to retain the freedom of choosing their own dentists?
Will the mode of treatment be determined by the patient and the dentist?
What type of routine and preventive dental care is covered? Does the plan cover braces, oral surgery, crowns and bridges, root canals and treatment of periodontal diseases?
Will the plan cover all diagnostic, preventive and emergency services? Including preventive services viz. sealants & fluoride treatments, which might result in financial savings to the patient in future? Does it provide for full-mouth x-rays?
What forms of major dental care is covered? Does the plan cover implants, dentures, or treatment for temporomandibular disorders?
Does the plan allow for specialist referrals? If so, has the dentist be limited to “the” list of specialists to choose form?
Does the plan provide for emergencies? What are the provisions made for emergency care when the patient is on tour?
What percentage of monthly premiums goes into actual care and not to administration?
The author is a dentist and a lawyer who sells iphone accessories.