Dental Insurance Introduction
Dental insurance assists patients by covering part of the costs for dental care and associated procedures. Having a dental insurance plan can considerably lower the costs of dental care, with an uninsured American citizen potentially paying thousands of dollars more than an insured individual when they require dental treatment. In this section we explore different facets of the US dental insurance system in detail, some of which are touched upon here by way of introduction.
Types of dental insurance
A large amount of dental insurance plans fall into two broad categories of managed care programs:
Preferred provider organizations
(PPO) set up a plan through which the insured individual can choose a particular dentist from a list of select practices who offer dental care at lower than typical rates.
Dental health maintenance organizations
(DHMO) are cheaper still and thus designed to accommodate a wider range of residents from lower income backgrounds. Certain services are offered free of charge to the patient, and the dentists under contract with DHMOs receive payment from the insurance company.
In addition to these, many dentists offer their own plans to assist patients with the financial concerns.
Dental insurance facts
The National Association of Dental Plans’ 2007 data shows insurance coverage in 57% of the US population, with 43% uninsured. Approximately 97% of the insured population receive dental insurance that is wholly separate from a health insurance plan, whether through a dental plan put in place by their employer or an individual policy. Those without dental insurance are significantly less likely to visit the dentist often, thereby increasing the risk of untreated tooth and gum damage. This is regularly due to a lack of means to pay for frequent examinations and treatment. However, despite the proliferation of managed care programs set up in part due to the Health Maintenance Organization Act of 1973, many Americans with insurance nevertheless struggle with meeting payments. The effectiveness of the managed care system is widely debated.
Charges and Limits
With managed care options, which include both PPO and DHMO insurance plans, the insurance provider will make a Usual, Customary and Reasonable (UCR) calculation based on the specific procedure, geographical location, cost of treatment and any other pertinent considerations. From this they work out how much they are willing to pay towards a patient’s dental care, and the rest of the responsibility falls on the patient. Broadly speaking, when treatment goes beyond the monetary limit of the provider’s ‘allowable charges,’ the patient can be expected to pay the rest. You should always check your insurance provider’s UCR charges for any treatment that you need.
As well as UCR considerations, most insurance plans cover the patient for a certain amount of dental services in a year, commonly with a threshold between $1000 and $1500. For treatment beyond the limit set by the insurance company, the patient may have to pay more toward the service.