Many American individual dental insurance and vision plans including family dental plans limit
the benefits--both in number of procedures and dollar amount--that are covered
in a given year. Be aware of these restrictions when choosing your plan and as
you and your dentist develop treatment best suited for you.
Major dental care includes:
restorations and individual crowns
Oral Surgery--removal of
impacted teeth and complex oral surgery procedures.
complicated periodontal disease requiring surgery involving bones, underlying
tissues or bone grafts.
including retainers, braces and/or diagnostic materials.
surgical placement or restoration
partial dentures and removable or fixed dentures.
Will the plan allow referrals to
specialists? Will my dentist and I be able to choose the specialist? Some plans
limit referrals to specialists. Your dentist may be required to refer you to a
limited selection of specialists who have contracted with the plan's third
party. You also may be required to get permission from the plan administrator
before being referred to a specialist. If you choose a plan with these
limitations, make sure qualified specialists are available in your area. Look
for a plan with a broad selection of different types of specialists.
plans are offered in the following states -
Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware,
Dist of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa,
Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan,
Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New
Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma,
Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee,
Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.
If you have children, you may
prefer a plan that allows a pediatric dentist to be your child's primary care
dentist. Since specialized treatment is generally more costly than routine care,
some plans discourage the use of specialists. While many general practitioners
are qualified to perform some specialized services, complex procedures often
require the skills of a dentist with special training. Discuss the options with
your dentist before deciding who is best qualified to deliver treatment.
Can you see the dentist when you
need to, and schedule appointment times convenient for you? Dentists
participating in closed panel or capitation plans may have select hours to see
plan patients. They may schedule appointments for these patients on given days,
or at specified hours of the day, restricting your access.
Some dentist's fees for seeing
you on weekends or during emergencies are high than those the plan allows. You
may be required to pay additional costs yourself. If you select these types of
plans, have a clear understanding of your dentist's policies as well as the
plan's dentist-to-patient ratio. It's the best way to ensure your access to care
is not unduly restricted and that you are not surprised by higher fees the plan
does not cover.
Insurance companies do their best
to ensure that their policyholders understand their plans and benefits, but it
is up to an individual to make sure that they are making informed choices. The
differences in the various plans you can choose from are:
The type of third party funding
Methods of selecting a dentist.
Compensation of the dentist's
services to you.
The calculations of benefits
Understanding these differences
will enable you to make an informed decision when selecting a dental plan that
is best for you or your family.