Like medical or health coverage, dental coverage protects your pocketbook from untimely issues associated with your teeth. In addition to providing benefits for major services like root canals or crowns, dental coverage will typically cover your cleanings.
Types of Dental Coverage
Preferred Provider Organization (PPO) Coverage These plans allow the dental patient to see a dentist whether that dentist is inside or outside of the plan’s network. The dental patient will pay a part of the cost of the dental procedure and the PPO will cover the rest. Typically, the percentage will vary based on the type of procedure; for example, the patient may only have to pay a small percentage of the cost of a cleaning but a higher percentage for a cosmetic procedure like getting crowns or braces.
Dental Health Maintenance Organization (DHMO) Coverage
These plans use provider networks. The dental patient will be able to get services from a dentist within the DHMO’s network for a lower rate. If it is necessary for the patient to see a specialist they will be referred to one by the dentist. These plans often provide shorter waiting periods and the patient may not be required to pay anything for preventive procedures like cleaning. However, it is necessary to see a dentist in the network to get these benefits, seeing out-of-network dentists often means that the patient will have to pay the whole bill out-of-pocket.
Dental Plans
These plans provide discounted dental coverage from dentists who are participating in the plan. There are no exclusions and very little paperwork. The patient simply signs up and visits a participating dentist to receive the discount.
Dental Insurance VS Dental Plans
Dental plans are often mistaken for a form of insurance but the truth is that the two forms of coverage are very different. For one thing, the method of applying for a dental plan is extremely simple. Dental insurance requires a lot of paperwork to be filled out and there is often a waiting period before any of the benefits are received. With a dental plan there is a simple form that once it is filled out, allows the dental patient to take advantage of the plan’s benefits. Dental plans offer discounts for every visit to a dentist, whereas the percentage that dental insurance pays may vary depending on the procedure or the dentist.
Major Medical Insurance Coverage
Major medical insurance does not cover dental or regular doctor visits. This form of health insurance is primarily for covering serious medical problems that require hospital stays and costly medical procedures. The patient must pay for any medical expense not covered by their major medical insurance plan. With major medical insurance, low deductibles mean higher premiums; the patient must carefully consider the monthly cost versus the out-of-pocket payment when shopping for this type of insurance.
The Importance of Dental Coverage
Premiums are paid every month whether the coverage is used or not; this can make it seem like a waste of money. However, health emergencies are unpredictable. In a situation where an individual urgently needs to pay for healthcare, being covered can help with everything from prescription drugs to a hospital stay. Even when it is not used, coverage can still provide security; those with coverage know that should there be an emergency, they will have the financial resources to withstand it.
Dental Claims Processing
The bill that a doctor turns over to a patient’s health insurance company is called a health insurance claim. The doctor will bill the insurance company for the cost of treatment less the patient’s copay. It is important for insured patients to understand that the health insurance company will only pay for what their policy covers; the patient is expected to pay the rest. Processing the doctor’s bill involves comparing it to the benefits of the policy to see what is covered. The insurer will pay for what the policy covers and bill the patient for anything that was not covered.