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Dental insurance plans can be a tough choice that many people have to make. Choosing the right dental insurance plan or dental plan (not insurance) requires that you do your homework so that you are covered in the event you need to use your dental coverage.
PPO (preferred provider organization) insurance plans are arrangements where the companies have a negotiated fee for service. There are specific schedules depending on the procedure in exchange for the dentist being put on a list of "preferred" providers. Employers give the list to their employees to match them up with dentists who participate with the dental plan. Dental insurance can help people pay for dental treatment, but it almost always has some limitations. Most insurance plans have a deductible that is at least $50 or $100. They will only pay a certain percentage for each type of treatment, and have maximum amount that can be spent each year on dental care.
Most of the PPO dental plans will cover preventive care such as cleanings, check-ups, protective dental sealants, x-rays, and fluoride treatments. They will usually cover 80% to 100% of the total cost. Basic care, including root canals, extractions, and fillings are usually covered at the rate of 80%. Major care such as crowns or caps, bridgework, and full or partial dentures as well as periodontal (gum) care are often covered at 50%. Many insurance companies have a yearly maximum amount that they will cover of $1000. Obviously, this can be used up very quickly with the high cost of dental care.
Dental plans are designed to pay only a portion of your dental expenses. Dental plans will usually exclude certain treatments, such as dental sealants, which can prevent tooth decay and save you money on future care. Read all literature provided with a dental plan and know the limitations. If a plan doesn't cover a procedure that is recommended by your dentist, or that you know you will require, consider an alternative plan.
Some dental plans do not cover pre-existing conditions. Others plans might not cover specialist referrals and other dental needs that are critical to you and your family. When your dentist recommends an appropriate treatment method for your condition, the contract provision of your dental plan may only pay a portion, or pay only for the least expensive alternative treatment as determined by the dental plan or dental insurance provider.
Dental plans include references to "usual, customary and reasonable" to determine the portion of the dental treatment they will pay. Usual, customary and reasonable (UCR) reimbursement levels are determined using different methods by the dental plan provider. They may vary a great deal among plans. The fee that the insurance company determines to be "fair" may be low compared to other plan's fee for the same dental services. The plans will then pay a percentage of the UCR level. You might be required to pay a greater percentage of the cost for that treatment.
Before you select a dental plan or dental insurance, there are some important things to consider. Most dental plans require patients to choose a dentist from a limited list of dentists. Obviously, this isn't exactly ideal, but this is the norm with dental insurance companies or dental plans. If your dentist is not on such a list, don't hesitate to ask why he or she has elected not to participate. The answer might surprise you.
Useful web sites related to dental insurance and dental health:
The American Dental Association
Dental Plans.com - For a dental plan quote.