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Index | Dental Insurance | Things to Consider Before Choosing Dental Insurance Plan

Things to Consider Before Choosing Dental Insurance Plan

Dental Insurance procures an effective way of treating your teeth and gums. If your Dental Insurance plan is well-chosen, you can receive the benefits of dental treatment and your dental care expenses will be considerably lower than the charges you will have to pay without insurance. The advantages of Dental Insurance are indisputable. However, choosing an effective Dental Insurance plan is not easy. It is of primary importance that you can take an active role in decisions regarding dental care. If you are ready to take actions to obtain the information, you can save yourself the trouble of looking for a dentist and paying quite a fortune when you are in need of dental treatment. Exploration is an essential part of choosing a Dental Plan. The more you know about the plan the better equipped you are, and therefore, the greater the likelihood that you will make a reasonable decision.

For a start, decide on how much coverage you need and how much you can afford to pay for it. It is as natural as it can be to search for an affordable Dental Plan which will represent an ideal combination of price and quality. Some plans restrict payment to the cheapest treatment for a specific condition. And if there are multiple treatment options available, your plan will pay for the least or less expensive treatment depending on the charges. If you are interested in quality treatment you will most likely want to have an extended coverage and it is reasonable to turn to other plans available. A very important factor to remember regarding any Dental Insurance Plan is who is responsible for treatment decisions. You should know if you and your dentist may decide on the treatment under your co-payment, or the cost control is fully predetermined in your contract and you have to comply with the guidelines set in your policy and get the least expensive treatment.

In financial terms it is worth considering whether the plan you find suitable is a co-payment or fee-for-service kind. In order to make sure you are not overpaying for your Dental Insurance and dental treatment you can use a Usual, Customary and Reasonable (UCR) fee guide which will give you an idea about the average fee charged by most dentists in the area for a certain procedure. It does not at all mean that your dentist will charge you the amount indicated in the UCR fee schedule as the contracts under which dentists work can be different. But it can give you a yardstick to determine if the dentist you have chosen requires too high a fee.

The cost of the policy is undoubtedly an important consideration to keep in mind, but there are other factors to take into account when choosing a dental insurance plan, among which the scope of the coverage comes first. Ideally, a good Dental Plan should cover diagnostic, preventive and emergency treatment. As an example, the following services should be covered by your plan without any co-payment: oral examination every time you visit a dentist, two cleanings a year, complete X-ray survey once in three months, fluoride treatment twice a year, sealants for those under the age of 18. The scope of coverage is reflected in the print of the plan, so read it carefully. All the categories of dental procedures should be covered, though, possibly, in different proportions: preventive and diagnostic care, basic dental procedures and emergency treatment. The extent and frequency of these services may vary, but you can arrange it with your dentist to pay directly for a portion of the basic dental care. Clients with modest incomes still can find good and affordable plans with a bit less coverage.

Preventive dental care may spare you the necessity of routine care, but when choosing a Dental Plan it makes sense to find out what routine care procedures are covered by the plan (restorative care, such as amalgam and composite fillings, oral surgery, including tooth pulling and minor surgical procedures, etc.). Generally, the cost of these procedures is not fully reimbursed by the insurance company. Find out how much your insurance company covers. On average, it is 70-80% of the charge.

When it comes to major dental care, it is also important to learn what major care procedures are provided by the plan and what percentage you will have to pay for them. Some plans cover less than 50% of major dental treatment and in can be too much for you. Therefore, if there are options, it is sensible to draw a line of comparison taking into account all the mentioned criteria.

One of the necessary steps to take when choosing a Dental Plan is to double-check your eligibility for dental coverage in order to avoid unpleasant surprises when you have already decided to sign up for a particular plan. It is a great advantage of the plan if it provides coverage for your dearest and nearest. That is why being a scrupulous consumer, you are sure to find out about the eligibility of your dependents for dental coverage.

Another point to consider is whether the plan you are interested in provides you with an opportunity to choose specialists you would like to apply to. For example, the Managed Care Plans require that you apply to participating dentists and facilities for all the services. This ensures lower fees you pay for the services applying to specialists working within the network of providers. If the plan requires you to see an In-Network dentist, it makes sense to get acquainted with the list of dentists working in the area and determine what insurance agencies they are contracted with. Some plans procure a provision according to which you can see an Out-of-Network dentist, which can be convenient if your current doctor does not belong to the network of providers. In this case, however, the company reimburses a lower portion of your dental care expenses.

If the condition enabling you to see only a designated dentist does not run counter to your expectations and suits your situation, it is still important to give a thorough consideration to some minutiae. For example, with Managed Care Plans you are usually required to choose your primary provider when you choose the plan. Be sure to call the dental office before applying for the plan to ensure that they have vacancies and are accepting new patients. It will spare you a lot of trouble and routine paper work later if it turns out that you cannot apply for treatment to the dentists you have chosen.

Another important thing you are recommended to check out before choosing a Dental Insurance Plan is whether there is a waiting period assigned to the plan and how long it is. If the plan you are likely to opt for has a 12-month or longer waiting period, you will have to pay for the services out-of-pocket for all this time as well as to pay the deductible and, possibly, premiums while you are waiting. Normally, the shorter the waiting period the sooner the effects of your coverage become tangible.

Trivial and natural as it is, it is very important to check in advance the area where the plan is in effect. Depending on your lifestyle, your work, the frequency and destination of your business trips, your choice of a Dental Care Plan can be conditioned by territorial considerations. If you travel, you may appear to be fully responsible for your dental care costs in a situation when you can not find a network dentist where you travel. In such a situation it is perfectly reasonable to select a plan under which you will be able to get dental treatment when you need it, whether you are at home or on a business trip.

Sometimes dentists schedule appointments on particular days of the week or limit their appointments to several times a week, which can be inconvenient for you. It is better to find out in advance whether you will be accepted when you need it and when it is convenient for you.

There are certain limitations and exclusions in most dental plans. It is necessary to pay special attention to so-called "clauses" and find out about the services initially not covered by the policy. There are two most frequent clauses - "a missing tooth clause" and "a replacement clause", in accordance with which no dental treatment will be covered by the insurance company if you had lost your teeth before the policy came into effect. There can be several important clauses in the policy and you should be aware of them and the possible implications they entail.

There is also a possibility that you are covered by two dental plans or you are considering purchasing another dental coverage. This situation requires you to carefully evaluate the benefits you are or will be eligible for under both plans. Analyzing your options, make sure you choose a plan with a Coordination of Benefits provision.

Before making your final choice, ask a representative of the insurance company to supply you with a copy of the benefits handbook where you will find detailed patient information about the coverage, its limitations and exclusions. Remember, it is your responsibility to get familiar with the plan's provisions. If you have questions about the coverage or calculation of benefits or any other important point, do not feel embarrassed to ask an insurance company representative before you take a decision. An informed decision can make your smile irresistibly charming and your life easier.