Getting the Most Out of Your Dental Insurance, Part 2 of 2

Last week, we started our discussion on how to manage your dental costs and maximize your dental insurance.  In these hard financial times, this is one way that can really help your financial budget.  

In Part 1 (last week), we laid the groundwork by explaining various terms.  We looked at:
  • What is Dental Insurance?
  • What are the various types of dental insurance plans?
  • What is typically covered?
  • What are the various options you have to choose from?

With a thorough understanding of the types of dental insurance plans, what is covered, and the options available, this week we look at:
  • What are the steps you should take to choose the right plan?
  • What should you do to make the most out of the benefits?

Here is what you need to know:

What are the steps you should take to choose the right plan?

In deciding on which type of plan or option is right for your family, you need to look into what is available to you and then, take a realistic look at what you expect the needs of your family to be in the coming year. You can then look at the financial impact and make a sound decision.  Here are some steps to follow:

  1. Review your policy--Many people already have dental insurance through their employer or a plan they may have signed up for previously. Often they have no idea what it offers or anything about it except the fact that they have it.  No matter what type of insurance you have or choose, you will want to read the fine print. Understanding what you are covered for is very important.
  2. Check with your provider to see what options you have--Here are some questions to ask.
    • Can you choose between a PPO or DHMO in a group plan?
    • Can you go outside the acceptable providers in a PPO or DHMO if you need to?
    • Under your PPO or DHMO, is there an option where you can increase the services you get for what you pay?
    • Do the dentist and the program allow a large enough treatment plan? You want to make sure your dentist offers the services you need.
    • Can your dentist submit pre-treatment estimates? This can make a difference in planning costly dental care.
    • Can you spread your treatment out? If you need something done that can be done in stages is that an option? It can allow you to spread services that will cost you a good bit over two calendar years.
    • Do you have alternatives? Implants – bridges – partial dentures or are you stuck with the Least Expensive Alternative Treatment (LEAT) no matter what you or the dentists want. In this case, if you choose anything else, you pay.
    • Teeth cleaning – usually twice a year some policies word it every six months and if you go in  before your six months are up – you pay.
    • Coverage on the kids – what is the cut-off age for kids? 18 or 19? How can you keep students on?
    • What services are covered? New treatments may not be.
    • Request that your premiums and the method of determining it be reviewed yearly.
  3. Check the credentials of your insurance company--Find out how the company offering your insurance is rated by other consumers and government agencies. Ask your friend and co-workers who use the program what they liked or disliked about the plan and any dentists on the lists. Ask the insurance company how they choose their dentists – what are their criteria?  Ask the dentist themselves what insurance companies they work with and why? Which ones do they refuse to work with?
  4. Consider how convenient it is to get services--Another area that you should be questioning is the services offered by your plan. If your dentist can not handle all the problems that arise, what other providers are on the list? What if you need a specialist? Is the selection of services great enough to cover your family?  If you have to choose from a pre-selected list of providers – how close is he to you? Do you need permission to see a specialist or have certain things done? How quickly will services be rendered—will you need to make several short appointments, or will a procedure be done in one visit?
  5. Consider the quality of care provided--This is especially important in a PPO or DHMO where, as we said, your quality of care could be affected by the lack of money coming into the dentist office. If your dentist is paid a flat monthly fee you really want to ask around.
  6. Consult with your dentist--Before deciding on the type of dental insurance or the options you should get, talk with your dentist regarding the extent of your treatment plan (and the treatment plans of your family members).  Your dentist's insurance coordinator can also help you make the right selection based on your treatment plan--potentially saving you thousands.
  7. Review the total costs--Choosing what your policy covers can affect the cost of the premium. If you are a single person you may feel you do not want the major expenses covered. Preventive care may be all you need. If you have kids and can’t afford a policy covering the whole family can you get one that just covers the kids?  What kind of deductible is required and is it an individual or family deductible? Or both? What is it going to cost you just to walk into the office? After you reach your deductible, what percentage of services are covered? What will it cost you if you have to choose a provider outside the company’s list? Does the plan provide limits for how much you will pay out of pocket? Is there a cap on what they pay yearly?  Are prescriptions covered?
  8. Compare total costs to treatment plan—Once you have determined the total estimated costs, you can compare the amount of work needed per your treatment plan, and see what level of insurance and what options make financial sense. Make sure you have a plan that provides you with the coverage you need as defined by the treatment plans your dentist has outlined.  
  9. Look for a good bargain--A dental plan offered by a company to its employees is often subsidized. 50% of the annual premium is paid by the company and the other 50% by the employee. If your company offers you, don’t hesitate. Employee dental plans are grouped, thus making the payments more affordable for employees. If your employer does not have a dental plan, you can ask them to set up a voluntary group plan—which does not cost the employer anything, but provides group rates to the employees.  If you can’t get insurance through an employer, see if you get into a group plan with friends, relatives, or professional associations.
  10. Get enough insurance for now and the near future--Consider what your future needs will be.  Do you have teens that will need braces? Will you be able to adjust your insurance to accommodate the future need later, or will the plan not cover pre-existing conditions when you try to upgrade?

Checking into the above items can make a big difference in the amount of payment you put out, the amount of care you receive, and the quality of care you receive.

What should I do to make the most out of the benefits?

The Top 10 most important things you can do to maximize your benefits include:

  1. Make sure you find a dentist who provides convenient, quality care and works with you to manage your dental health and costs.
  2. Make sure to visit your dentist regularly for preventive care so as to avoid costly emergency procedures.
  3. Have your dentist work with you to develop a thorough treatment plan that both satisfies your dental needs while also satisfying your aesthetic desires,
  4. Map out a plan with your dentist and their insurance coordinator to determine how you will use insurance to support your treatment plan, including any wish list procedures you may want (e.g., orthodontics).
  5. Be sure to get the right insurance plan that meets both short- and long-term needs of you and your family (as identified in the treatment plans).
  6. Discuss with your dentist and their insurance coordinator ways to split expensive procedures across years so that you can spread the costs to take advantage of the yearly maximums..
  7. Discuss with your dentists ways to cover the additional costs above and beyond the insurance coverage.  They will have financing options they can provide you and should be willing to work with you on financial arrangement that meets your needs.
  8. Make sure to use all of your coverage within the calendar year.  Be sure to schedule year-end visits before December so that any work requiring multiple visits can be completed to make use of your annual insurance reimbursement allowance.  Remember, if you don’t use the yearly maximum within the calendar year, you lose the chance to use it.
  9. Be on the alert for special offers for dental procedures from dentists and/or dental manufacturers.  These can augment your coverage to allow you to get procedures done that you otherwise could not afford.
  10. Check to see if your dentist offers a discount for referrals.  Many do, and it is a great way to stretch your dental dollar!

Summary

With a little review and up front planning with your dentist regarding your dental needs, you can both insure your oral and dental health as well as potentially save a great deal of money by selecting the right insurance plan for your needs, and making use of all its benefits.

Here's wishing you and your family the good oral and dental health that you deserve!

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

Posted by Esthetique Dentistry at 6/29/2010 12:36 PM
Categories: Dental Insurance
Tags: Dental insurance benefits Dental Insurance
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