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Dental FAQ's

How does dental insurance work?

Dental insurance works in much the same way that medical insurance works. For a specific monthly rate (or "premium"), you are entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia.

What kinds of dental plans are available?

Like health insurance plans, dental insurance plans are usually categorized as either indemnity or managed-care plans (Dental PPO plans fit in this latter category). Put broadly, the major differences concern choice of dental care providers, out-of-pocket costs and how bills are paid. Typically, indemnity plans offer a broader selection of dental care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your insurance company).

Managed-care plans typically maintain dental provider networks. Dentists participating in a network agree to perform services for patients at pre-negotiated rates and usually will submit the claim to the dental insurance company for you. In general, you'll have less paperwork and lower out-of-pocket costs with a managed-care dental plan and a broader choice of dentists with an indemnity plan.

What is the best dental plan for me?

Although there is no one "best" dental insurance plan, some plans may work better for you and your family than others. Plans differ primarily in how much you'll have to pay monthly for your coverage and how much you'll have to pay when dental services are rendered. Some plans will require that you pay a certain co-payment for services, or meet a specific deductible before the dental insurance company begins payment. Other plans may limit coverage to a specific dollar-amount maximum per year.

When reviewing your dental insurance options, here are a few questions to ask yourself:
  • How much will it cost me on a monthly basis?
  • Will I be required to meet a deductible? Once the deductible is met, how much will the dental insurance provider pay for my services?
  • What dentists participate in the plan's network? Are these dentists that my family and I would like to see?
  • If I used a dentist outside the plan's network, how much will I have to pay?
  • Are there waiting periods for certain procedures?

What is a Dental PPO?

Dental PPO (Preferred Provider Organization or Participating Provider Organization) plans are perhaps the most common type of managed care dental insurance plans. Most Dental PPO plans require you to pay a deductible. With a Dental PPO plan, the patient typically obtains care through a network of dental providers who agree to serve the plan's members at reduced rates. When you use a network provider, you will typically pay a certain percentage (e.g. 20%) of the reduced rate, and the insurance company will pay the remaining percentage (e.g. 80%).

As a member of a Dental PPO plan, you may use dentists outside of the Dental PPO plan network, but you will typically only be reimbursed based on the amount that a network dentist would have accepted as payment in full. The rest of the total charges will be considered the patient's responsibility.
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