Like any other insurance plan, dental coverage has its own
unique nuances. As there are a number of different available plans, each of
which cover different services and treatments, many may find themselves
overwhelmed when it comes to selecting an insurance plan that provides adequate
coverage without costing an arm and a leg.
Paying for Dental
Coverage
Unlike medical insurance, dental insurance is designed to
cover regular preventive care needed to keep the mouth healthy. How dental
coverage works is very much reflective of this theme, emphasizing low cost
preventive care while requiring greater patient financial responsibility when
it comes to more extensive restorative treatments.
As a result, paying for dental care plays a significant role
in selecting coverage. Paying for dental services can typically be divided into
four groups, based on how much each procedure costs and who pays the services.
With direct
reimbursement programs, the patient pays the dental fees and is reimbursed
a specific amount based on specific percentage of the overall cost of treatment
rather than by the cost of each procedure. Unlike other insurance plans, direct
reimbursement allows patients to visit whichever dentist they would like rather
than restricting them to a list of approved “in-network” dentists.
Similar to direct reimbursement, usual, customary, and reasonable (UCR) plans allow patients to
visit whichever dentist they would like. Fees are set by the dentist and split
by the insurance provider and patient based on a predetermined limit. As the
dentist sets the fees, the cost of care may vary depending on where you are,
making dental care more expensive in one area rather than another.
Table or Schedule of
Allowance based programs will pay a certain amount of the procedure,
regardless of what the dentist sets the cost of care at. If the covered
services are more than what the insurance plan will pay, patients are
responsible for the remaining balance. Depending on the insurance plan,
patients may find it to be more economically savvy to stay within a network of
pre-approved dentists.
Lastly, capitation
programs pay monthly fees to contracted dentists based on the number of
enrolled families or patients at the practice. In return, patients can receive
treatment at no cost or at a discounted rate, known as the co-payment. However,
as treatment needs may vary, available treatments may not fully cover the care
needed to address the dental issue, requiring greater out-of-pocket
contributions by the patients.
Dental insurance can quickly become complicated and
overwhelming for patients unfamiliar with the insurance process. At Gies Family Dental, our dental team can help you determine which coverage works best for
your unique needs.
For patients without access to dental insurance, our San Antonio dental office also offers an in-office benefits plan that includes biannual cleanings, twice yearly x-rays, and unlimited emergency care. For more information about our in-office benefit plan, contact our San Antonio dentist today.
For patients without access to dental insurance, our San Antonio dental office also offers an in-office benefits plan that includes biannual cleanings, twice yearly x-rays, and unlimited emergency care. For more information about our in-office benefit plan, contact our San Antonio dentist today.