Choosing Insurance
Dr. John I have decided to obtain dental insurance for myself and my family, how do I decide which plan is best?
Jerry, Millbrae
Without a doubt, there are a very large number of dental plans available. Many plans will only be available to groups and not individuals. Generally speaking, when researching dental plans you will find that the various products will fall into one of the following categories.
Traditional fee for service Plan:
This type of dental insurance plan makes payment for the dental treatment received by the covered individual on a traditional fee-for-service basis. For some dental treatments (exams and cleanings), the payment made by the insurance company might be one hundred percent. For other types of dental services, the rate of reimbursement might be between 50%-80%. If the reimbursement from the insurance is less than 100% of the fee billed, the patient is responsible for payment and this is called a co-payment or patient portion. Traditional plans generally allow the patient to see the dentist of their choice.
Managed Care Dental Insurance Plans:
These plans are typically know as PPO’S , preferred provider organizations and DMO’s, dental maintenance organizations. All the managed care plans are developed with cost cutting in mind and as such, you may or may not receive the same coverage as one would with the traditional plan.
PPO: With cost cutting in mind, the insurance company contracts with a number of dentists to form a network of dental providers. As a part of the negotiation with the dental insurance company the dentist, in return for being included in the network and hopefully receiving an increased patient load, has agreed to discount their fees. The members of the dental plan must select from this list of network providers when choosing a dentist. If a member selects to see a dentist outside the discount network, chances are the reimbursement rate will be substantially lower or there will be no coverage at all.
DMO'S: A fixed amount per member who has chosen them to provide their dental treatment. In return, it is the dentist's obligation is to provide any and all needed dental treatment for these individuals (as specified by the conditions of the dental plan) during this period. In this type of plan, the dentist actually makes more money if they never see the patient! For example, a typical capitation rate might be $12 per month, per patient and the plan assigns 300 members to the office. The dental office then receives a check every month for $3600, for that $3600 the dentist must provide any and all dental work required by the plan for 300 members! Often basic services are provided without co-payments and major services require a patient portion.
Of course knowing that the dentist is paid a fixed amount per plan member regardless of how much dental treatment is provided should bring some other questions to your mind. What is the reputation of the dental plan? Are there individuals you can ask about how they interpret the care they have received? Did it seem that a full range of treatment options were offered to them as a remedy for a particular dental problem or that just the quickest, cheapest fix was suggested?
I have only touched on the generalities of dental insurance and suggest you contact an expert to help you with your selection.
WMDS, Inc. (11/19/03). dental plans/dental ins.http://www.animated-teeth.com/dental_insurance/t4_dental_insurance.htm
