Navigating Dental Insurance

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.