ALT="The Insurance Problem Solver, dental insurance"We discussed the generalities of dental insurance in a previous blog post. Here’s your bridge to some specifics.

The main varieties of genuine dental insurance are these:

  • Dental PPO Plans (DPPO). “PPO” stands for Preferred Provider Organization. DPPO’s use a network of providers to deliver dental services to members. The members pay a periodic premium for coverage. The provider agrees to accept a lower fee for a procedure than he or she would ordinarily charge. However, a co-payment is your responsibility for each service obtained. For example, the dentist may have a contract with the DPPO to charge a total of $1000 for a crown. The contract between the dentist and the DPPO may provide that of that the DPPO pays $500. The member is responsible for the rest.
  • Dental HMO Plans (DHMO). This is conceptually similar to a Health Maintenance Organization (HMO) but is limited to dental care. DHMO’s require you to select a dentist or dental facility to coordinate all care. There will be a primary care dentist for routine services, but if a specialist is required, you will need to get prior authorization and referral to the specialist. In this kind of dental plan, a bucket of routine services, including preventative care, is included as part of the premium paid by the member.
  • Fee-for-Service Plans. This kind of arrangement is like the indemnity major medical plan that you may have for health/medical insurance. The dentist bills the dental insurer and it pays the dentist, subject to a deductible or co-pay that is your responsibility. When you buy the dental insurance, you select a deductible and a co-payment that define your financial responsibility. Higher deductibles and co-payments translate to lower premiums and vice versa. There may also be a maximum payable by the insurer over the policy period.

But there are other ways to handle dental insurance options without breaking the bank:

  • Dental Discount Plans. Discount Plans are not insurance. They entitle you to a reduced fee from a participating dentist for specified services, but you are responsible for paying the entire amount of the reduced fee. To get the reduced fee, you have to “join” the discount plan for an amount of money and use a dentist that has agreed to render services. Once again, there are counterparts to discount plans for medical care. But, exclusively medical discount plans do not apply to dental care and exclusively dental discount plans do not apply to medical care.
  • The “ASK” Dental Plan. In addition to all of the formal types of dental plans, never forget the power of politely asking your dentist for a discount or for payment terms. Don’t approach it with a sense of entitlement, because you are not entitled. You need the dentist’s services, and he or she may like to have you as a patient. Be fair, reasonable and ask, don’t demand. You may be pleasantly surprised. Also, depending on circumstances, the ol’ barter system may work. I could tell you stories about my father, but you may not believe me.

Other Consumer Considerations

  • Despite the outward similarities between some forms of health/medical insurance and some forms of dental insurance (like the first 3 above), the maximum amounts payable under dental insurance plans are usually much less than under their health/medical insurance counterparts. Also, sometimes, there are sub-limits so that there is a separate maximum payable per year for different types of procedures. Because of that, it may be important to plan the timing of non-critical dental procedures to maximize benefits.
  • There may be pre-existing condition limitations on the coverage of dental procedures.
  • Waiting periods may apply. You may have to be a member of the dental plan for a stated period of time before the insurance will apply to certain procedures.
  • Before starting a course of dental care, make sure that the dentist is then-currently a participating provider. This is best done by contacting the dental insurer itself. Make note of when you called and to whom you spoke. You want verification that your dentist is an approved provider. Sometimes providers cease participation; if you have not been to that dentist for a while, you may not know that he or she no longer participates in the plan. This is particularly true with discount plans; in fact, some providers may not knowingly be members of the provider list. Therefore, you should also contact the dentist directly and confirm both his or her participation and that the amount of the discount is as represented by the plan.
  • If the dental insurer requires the submission of a proposed treatment plan, do not schedule the dental work until your dentist has submitted it, it has been approved or modified, and you know what your financial responsibility will be. Needless to say, you also need a plan for how to pay your share.
  • Last, but certainly not least, it is vital that you do business ONLY with a dental insurer that is authorized (licensed) to transact insurance business in your state. Many states even require discount plans to be registered to transact business despite not being risk-bearing entities. Contact the Department of Insurance for verification.

What Are the Major Dental Insurance Options And Company Players?

There are many dental insurance companies of varying sizes that operate throughout the country. Some specialize in group dental insurance products and some in individual dental insurance products; many sell both.

Although the following is not a comprehensive list of all dental insurance companies, these are some of the biggest:

Which is “the best”? I’m not about to touch that one. All have strengths and weaknesses, and cost alone does not make one a winner or a loser. If I had to give one major factor on which to base your choice, all other things being equal, I’d say to look at how claims are handled. Ask co-workers, ask friends, ask insurance agents and insurance brokers, and…ask DENTISTS.

Remember, I don’t sell insurance of any kind. I’m Luke Brown, The Insurance Problem Solver. I am here to get you to think about insurance, educate you about insurance, and answer your questions about insurance. Incidentally, I am also available to write about insurance for insurance companies, agencies, brokers, publishers, and websites.