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The California Dental Association Guide
The dental information listed below in this page is from: Selecting And Using Dental Benefits : A Consumer's Guide To Dental Insurance. A guide published by California Dental Association.
Dental Insurance Is Helping Keep America Healthy
The availability of dental insurance is the single greatest factor in helping you get the dental care you need. More than 48 percent of all Americans--113 million of us--are covered by privately financed dental insurance plans. This compares with just 12 million people who had such coverage in 1970.
Eight Things To Consider When Choosing Your Dental Plan
What looks like a bargain today may not be a good buy in the long run. While your out-of-pocket costs are, of course, an important part of your decision-making process when choosing a dental plan, they are not the only criteria to use when evaluating your options. Your primary focus should be to determine whether the coverage will satisfy your dental care needs. Consider the following:
Does the plan give you the freedom to choose your own dentist or are you restricted to a panel of dentists selected by the insurance company?
Who controls treatment decisions--you and your dentist or the dental plan? Many plans require dentists to follow treatment plans that rely on a Least Expensive Alternative Treatment (LEAT) approach. If there are multiple treatment options for a specific condition, the plan will pay for the less expensive treatment option. If you choose a treatment option that may better suit your individual needs and your long-term oral health, you will be responsible for paying the difference in costs. It's important to know who makes the treatment decisions under your plan.
Does the plan cover diagnostic, preventive and emergency services? If so, to what extent? Most dental plans provide coverage for selected diagnostic services, preventive care and emergency treatment that are basic for maintaining good oral health.
Every dental care plan is different. It's your responsibility to be informed about what your specific plan will cover.
What routine corrective treatment is covered by the dental plan? What share of the costs will be yours? While preventive care lessens the risk of serious dental disease, additional treatment may be required to ensure optimal health. A broad range of treatment can be defined as routine. Most plans cover 70 percent to 80 percent of such treatment. Patients are responsible for the remaining costs. Examples of routine care include:
Restorative care - amalgam and composite resin fillings and stainless steel crowns
- Endodontics - treatment of root canals and removal of tooth nerves
Oral Surgery - tooth removal (not including bony impaction) and minor surgical
procedures such as tissue biopsy and drainage of minor oral infections.
Periodontics - treatment of uncomplicated periodontal disease including scaling, root
planning and management of acute infections or lesions
Prosthodontics--repair and/or relining or reseating of existing dentures and bridges.
What major dental care is covered by the plan? What percentage of these costs will you be required to pay? Since dental benefits encourage you to get preventive care, which often eliminates the need for major dental work, most plans are not generous when it comes to paying for major dental work, most plans cover less than 50 percent of the cost of major treatment.
Will the plan allow referrals to specialists? Will my dentist and I be able to choose the specialist? Some plans limit referrals to specialists. Your dentist may be required to refer you to a limited selection of specialists who have contracted with the plan's third party. You also may be required to get permission from the plan administrator before being referred to a specialist. If you choose a plan with these limitations, make sure qualified specialists are available in your area. Look for a plan with a broad selection of different types of specialists. If you have children, you may prefer a plan that allows a pediatric dentist to be your child's primary care dentist.
Can you see the dentist when you need to, and schedule appointment times convenient for you? Dentists participating in closed panel or capitation plans may have select hours to see plan patients.
Will the plan provide benefits to patients who may also be covered by another dental plan? It is not unusual to be eligible for dual benefits. You may be covered under your company's plan as well as under that of your spouse's employer. In analyzing your options, make sure to look for a plan that allows coordination of benefits.
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