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Dental Insurance Explained
Dental insurance is equally important to health
insurance because dental disease is still prevalent. Being protected
by a dental plan and using it wisely are necessary safeguards
for your entire family. Unlike medical ailments, which are usually
unpredictable, most dental problems are preventable. Checkups
and cleanings are the way to keep teeth healthy. With regular
preventing care, problems are diagnosed in time and can
be treated with less expense to both, insurer and insured, keeping
the costs of dental care much lower than medical care. Generally,
a local dentist provides dental care, even though sometimes the
services of a specialist are required.
Consumers can choose the type of third
party responsible for funding and administration of their plan.
The primary responsibility of the third party is to provide the
financial foundation for your dental benefits plan. There are
three types of third parties. Dental Service Corporations:
not-for-profit organizations to negotiate and administer contracts
for dental care to individuals or specific groups of patients.
Insurance Carriers: for-profit companies underwrite the
financial risk of, and process payment claims for, dental services.
Carriers contract with individuals or patient groups to offer
a variety of dental benefits packages, often including both fee-for-service
and managed care plans. Self-Funded Insurers: companies
use their own funds to underwrite the expense of providing dental
care to their employees. The company pays for the dental costs
of its employees, usually with limitations on services and fixed-dollar
allocations.
Dental benefits plans can be categorized by the
options offered for selecting a dentist. Some plans allow
you the freedom to choose your own dentist, while others,
in exchange for lower rates, limit your choice. These two
alternatives are called open and closed panel plans. Open Panel:
This type of dental benefits plan allows covered patients to receive
care from any dentist and allows any dentist to participate. Any
dentist may accept or refuse to treat patients enrolled in the
plan. Open panel plans often are described as freedom of choice
plans. Closed Panel: This type of plan allows covered patients
to receive care only from dentists who have signed a contract
of participation with the third party. The third party contracts
with a certain percentage of dentists within a particular geographic
area. There are two types of closed panel plans. Preferred
Provider Organization (PPO) - This plan allows a particular
group of patients to receive dental care from a defined panel
of dentists. The participating dentist agrees to charge less than
usual fees to this specific patient base, providing savings for
the plan purchaser. If the patient chooses to see a dentist who
is not designated as a "preferred provider," that patient
may be required to pay a greater share of the fee-for-service.
Exclusive Provider Organization (EPO) - This closed panel
plan allows a particular group of patients to receive dental care
only from participating dentists. Although there may be some exceptions
for emergency and out-of-area care, if a patient decides to see
a dentist, which is not listed on the EPO panel, charges for service
will not be covered by the plan. Because participating dentists
are required to offer substantial fee reductions, many dentists
elect not to participate in EPO-type plans. Under some benefits
plans, participating dentists may be salaried employees of the
EPO. An EPO contracts with a limited number of practitioners within
a geographic area. Access to necessary specialized care can be
restricted. The EPO also may limit the amount of services that
a patient can receive in a given calendar year.
Today's health insurance, including your dental
plan, is designed to help you get the care you need at a reasonable
cost. Because each person's oral health is different, costs
can vary widely. To control dental treatment costs, most plans
will limit the amount of care you can receive in a given year.
This is done by placing a dollar "cap" or limit on the
amount of benefits you can receive, or by restricting the number
or type of services that are covered. Some plans may totally exclude
certain services or treatment to lower costs.
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