{"id":11386,"date":"2012-09-05T12:19:45","date_gmt":"2012-09-05T16:19:45","guid":{"rendered":"http:\/\/www.unionvilletimes.com\/?p=11386"},"modified":"2012-09-05T12:19:45","modified_gmt":"2012-09-05T16:19:45","slug":"make-the-most-of-your-dental-insurance","status":"publish","type":"post","link":"https:\/\/www.unionvilletimes.com\/?p=11386","title":{"rendered":"Make the most of your dental insurance"},"content":{"rendered":"

Knowing your plan and your options can save you money and keep you healthier<\/span><\/strong><\/em><\/span><\/p>\n

By Dr. Stephanie McGann, <\/strong>DMD, FAGD<\/strong>, Columnist, The Times<\/span><\/em><\/span><\/p>\n

\"\"<\/a>If you have dental benefits, congratulations! \u2013 You\u2019re one of the lucky ones. Many folks have no benefits.\u00a0 Too many of us have very little idea how our plans work and how much they actually cover.\u00a0 This is unfortunate and often works to the benefit of the insurance carriers themselves. Their job (being realistic here) is to make money for their shareholders. The fewer claims they actually pay the more profit they can report.<\/p>\n

In order to maximize your dental benefits it is important to first know what type of dental coverage you have. There are 4 major types of dental benefits each has limitations to the benefits they provide. While no plan covers everything, some may be better suited for you and your family.<\/p>\n

Traditional indemnity plan:<\/strong><\/p>\n

This plan allows a patient to visit the provider of their choice. The plan pays for services based on the service type and a percentage of the provider\u2019s fee. In some cases they use arbitrary amounts (former known as UCR) to determine the amount they pay.\u00a0 With these plans the patient pays the provider the difference between the actual fee and insurance payment.<\/p>\n

PPO \u2013 Preferred Provider Organization Plans:<\/strong><\/p>\n

This is the \u201cnew\u201d indemnity or Fee for Service plan. It usually comes with two options.<\/p>\n

Option 1 \u2014 Out-Of-Network: A subscriber can visit the provider of his choice and have a traditional plan. The plan pays based on a percentage and subscriber (patient) pays the difference.<\/p>\n

Option 2 \u2014 In-Network: In this situation the dentist has signed an agreement with a carrier to a set pre-determined fee schedule.\u00a0 The provider bills the insurance carrier their regular fee, the carriers pays the difference and determines the patient co-pay. The provider must write off the difference between their standard fee and the contracted fee schedule. Using this option can save patient money if a provider of their choice is on the list, but it can limit your options. While no insurance covers everything, many PPO\u2019s offer reduced fees for services that normally are not covered by traditional dental insurance, including some cosmetic dental procedures.<\/p>\n

It is important to note that almost all PPO plans have the out-of-network option. Out of network does not always mean it costs more money.<\/p>\n

DMO \u2013 Dental Maintenance Organizations \u2013 the dental HMO:<\/strong><\/p>\n

These plans are usually not beneficial to the patient or the provider.\u00a0 A patient with a DMO plan can only visit the dentist they chose when they enrolled. If they did not choose, one is chosen for them.\u00a0 That dentist is compensated on a capitation program \u2014 or “per head” basis. They are paid \u201cper head\u201d based on the number of enrollees on their \u201clist.\u201d These contract dentists are prepaid to provide certain services for the patients on the list. To get the most out of these plans, be sure to schedule appointments well in advance.<\/p>\n

Direct Reimbursement (DR):<\/strong><\/p>\n

A\u00a0 DR plan is the least complicated and most beneficial for patients. In a typical direct reimbursement plan the patient pays for their care and is reimbursed by their employer or plan administrator. \u00a0In every case the employer is ultimately paying the claims \u2013 this is a benefit plan not insurance.\u00a0 The employer group will set maximum limits as to what an employee and their family is eligible for.\u00a0 Because there is usually less overhead in the DR plan patients often get better levels of benefits. It is important to check out the specifics of any plan before signing up.<\/p>\n

There are some simple tricks to maximizing your benefits, too:<\/p>\n

    \n
  1. Find out if your plan runs on a calendar year or some other date.<\/li>\n
  2. Find out if you are eligible for cleanings every six months or twice yearly. (this makes a difference)<\/li>\n
  3. How often does your plan cover complete (full) x-ray series?<\/li>\n
  4. What is your annual maximum?<\/li>\n
  5. Ask for a copy of your benefits \u2013 you pay for the coverage you are entitled to the information.<\/li>\n<\/ol>\n

    If you are eligible for cleanings twice a year, be sure to schedule two each year. If you are an every 6 months then schedule two but be sure 6 full months are between the visits. Even one day \u201ctoo soon\u201d and they won\u2019t cover you. Please don\u2019t ask your dentist to fudge the date, that is insurance fraud and everyone can go to jail.\u00a0 Most plans cover preventive services at 100%; don\u2019t waste these valuable benefits.<\/p>\n

    Annual maximums are the max amount the carrier will pay on your behalf. These are \u201cuse it or lose it\u201d benefits.\u00a0 Most plans have a $1500 max, so it is important to not put off treatment if you still have benefits remaining. Savvy patients will schedule procedures before the end of the year so they can take advantage of all of the dental dollars they are entitled too.\u00a0 If it\u2019s fall and you still have benefits left, speak with your dentist and see if there are concerns that should be addressed prior to the year end. It\u2019s often better to replace and old filling or place a crown on a cracked tooth before it becomes an emergency and ultimately more costly.\u00a0 Yes, it\u2019s true; a stitch in time saves nine.<\/p>\n

    If your plan offers a participating dentist option, choose carefully and learn what the pro\u2019s and con\u2019s of your plan are. Not all networks are the same. Always check if a specialist is available in your area before you sign up for a plan.\u00a0 If you have to travel 100 miles to see a specialist your network might not be the best deal.<\/p>\n

    Don\u2019t assume your dentist knows your plan. Each employer that offers dental benefits to their employees negotiates the specifics of the plan when they purchase it.\u00a0 In some larger companies they offer benefit level options. So what you have and what the person who works next to you have isn\u2019t always the same.<\/p>\n

    What all this means? If you have benefits don\u2019t waste them. If you don\u2019t have benefits, talk to your dentist about ways to keep your mouth healthy and avoid costly unexpected dental problems.<\/p>\n

    Dr. Stephanie McGann is a resident of the Unionville area and along with her partner, Dr. Marie Scott, operates The Brandywine Smile Center<\/a>, a family-friendly dental practice in Concordville. She is a Fellow of the Academy of General Dentistry.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    Knowing your plan and your options can save you money and keep you healthier By Dr. Stephanie McGann, DMD, FAGD, Columnist, The Times If you have dental benefits, congratulations! \u2013 You\u2019re one of the lucky ones. Many folks have no benefits.\u00a0 Too many of us have very little idea how our plans work and how […]<\/p>\n","protected":false},"author":1,"featured_media":11391,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,403],"tags":[809,1864,1867,1866,1865],"class_list":["post-11386","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-featured","category-health","tag-benefits","tag-dental-insurance","tag-dmo","tag-indemnity","tag-ppo"],"_links":{"self":[{"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=\/wp\/v2\/posts\/11386","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=11386"}],"version-history":[{"count":0,"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=\/wp\/v2\/posts\/11386\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=\/wp\/v2\/media\/11391"}],"wp:attachment":[{"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=11386"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=11386"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.unionvilletimes.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=11386"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}