Selecting an Insurance Company
When choosing a dental insurance company
you should consider the following:
Regardless of what dental
insurance you choose/have, ask your dentist to submit a copy of your proposed treatment
plan for an " estimation of benefits". This estimation of "out of pocket
expense" will help clear the air of denied benefits.
Do you have the right to choose your own dentist?
If you do have the right to choose your own dentist does
your co-payment increase?
Do they have their own fee schedule? If they pay 100% of
$10.00 fee while the procedure costs considerably more, you're left holding the bag!
Ask to see a fee schedule.
Number of cleanings per year? 2 is the standard, 4 is
optimum.
dental sealants with no age limit?
reimbursement rates adjusted annually?
About 1-5% of adults have some sort of temporal mandibular
joint (TMJ) problems. Progressive insurance dental insurance will have treatment for this
as a covered benefit.
Are diagnostic services such as: study models, photographs,
CT scans, and lateral tomograms, a covered benefit?
Is preventive dental care ( cleanings, x-rays, exam,)
waived from your deductible? Most insurances are.
Are your dependents covered while in college? This is a
covered benefit for most insurance companies.
Are preexisting dental conditions a covered benefit? Only
progressive insurance companies include this.
100% for preventive work
80% for routine work
50% for majorwork
progressive insurance companies increase these percentages the longer you're on the plan.
Typically
deductible is $ 50.00 Maximum yearly benefit is $1000.00 More progressive
insurance plans are now $2000.00
Is there orthodontic coverage?
·How long has the insurance company been in business?
Does the insurance company participate
in electronic billing?
You can request an annual report of any
publicly traded company and check out administrative costs/salaries and actual
expenditures on providing care.
Often times a dental insurance policy has some vague
wording under covered benefits.
Wording such as " payable under special circumstances with appropriate x-rays and documentation"… are more than likely NOT payable benefits.
Some dental benefits are denied because of a "
consultant’s " review. Ask the insurance company. If you can have personal
access to the consultant that reviewed your claim? Are the consultants employees or
independent reviewers? If consultants are employees, ask for their employment
criteria.
Often times dental insurance policies reserve the right to
pay for the " less inexpensive alternative". This usually involves ,but not
limited to, more advanced procedures, newer technology , and cosmetic dentistry.
The average dental insurance company spends 28-35% to
administer the plan while the balance of 65-72% is actually spent on dental benefits. If
you own your own company or would like to save your company a big chunk of money you
should consider a self-administrated dental plan. These are called" direct
reimbursement" plans. There are several free services/foundation set up to show you
how to self insure: Connect to the "The
Dental Benefits Advisory" now by clicking here.
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