Dental Insurance

 Let's face it, there are many insurance companies out there.  They are just like most companies and they offer a product and want to make a profit by selling that product.  It can be very confusing, even for people that deal with insurance on a daily basis.  Just when you think you have an insurance figured out, they change things.  They have ryders within the policy that make utilizing their product more difficult.  They can also put in items such as a "Missing Tooth Clause, "   " Replacement Clause,"  and "Frequency Limitation."  It can be confusing but we hope to clear up some of the most asked questions with this blog.  And of course, if you have any other questions, you can always call our office, Care Dental Spa, at 254-773-0055 or your Insurance Company.  There is usually their phone number on the back of the card.

 

There are several different types of insurance plans.  The indemnity plan is a type of insurance that is fairly straightforward.  They usually have a deductible which must be met on certain procedures and they usually have an individual and family deductible.  This is usually a once a year occurrence.  The maximum is what the insurance will pay towards services rendered in a certain time span.  Once the maximum has been met, the insurance company will not pay anything.  The cost incurred is now the patient's responsibility, in full. Most indemnity plans will pay 100% of the "usual and customary" fees for preventative and diagnostic.  What does the "usual and customary"   mean?  This term means that your insurance company will pay what they feel is a fair price.  Let's say their UCR is $50.00 for an X-ray; however, your dentist's fee is $60.00.  This means that your insurance will pay $50.00 and you are responsible for $10.00.  The same goes for any other procedures done. Also keep in mind that your deductible might come into play.  There is no guarantee of payment until your insurance company receives the claim and processes it.  Your insurance has all the power as to whether or not they will pay for services rendered by your dentist.  We can send in a pre-determination; however, that still is not a guarantee that your insurance will pay.

 

Another type of insurance is a PPO or POS type plan.  This type of insurance is one that has certain providers that have agreed to accept their fee schedule.  Those providers have signed a contract stating that their fees will be dictated by the insurance company.  The only recourse for providers to do otherwise is to explain to the patient that their insurance does not pay for a certain service and should the patient want that service they will pay out of pocket for whatever the insurance does not pay.  We will explain this and have a patient sign a treatment plan.  This type of Insurance usually has a deductible and maximum amount.  Patients will automatically get a discounted rate for services that their insurance will pay.  An example would be, you go to a dental office that accepts your PPO insurance.  You get a filling done.  The dentist's fee for service is $100.00 for that filling.  Your insurance's fee schedule dictates that the cost for that filling is $85.00.  The dental office can only charge you the $85.00 for that filling and the difference of $15.00 is written off.  Your portion (deductible and coinsurance) will be collected when services are rendered.  Another aspect of this type of insurance is that you can go out of network.  You will have to pay more out of pocket if your dentist is not in network, but you do have a choice to go out of network.

There is also a plan called a DHMO.  It is basically an HMO type plan for dental.  Dr. Luong is NOT participating provider for any of these types of plans.  The insurance will allow you to choose, from a list of their providers, one of their in network dentists.  You are then locked in to that dentist.  You have to go to that dentist for all of your dental needs.  If you go out of network, this type of insurance will NOT pay anything.  You will have to pay in full.  If your in network dentist cannot provide  a particular service, he must obtain a referral to go to another facility.  It must be approved and authorized by your insurance in order for them to pay for those services.  The DHMO plan usually has a copayment that you will be responsible to pay.  Most of the time you will not have a deductible but it really depends on the plan that you choose.  It is not uncommon to also have a maximum for the year. This type of plan locks you in to their dentists and services that they provide.  It is usually cheaper than other types of insurance; however, you pay for what you get.

 

The last type is not really insurance.  It is a discount plan.  You pay a company for a year  and you receive a discounted rate for all services, as long as you go to a facility that is a provider for the discount plan.  This type of plan is great for those individuals that do not have dental insurance.  Just keep in mind that the providers do not receive any compensation from your discount plan.  The patients are paying for the services in full, but they get a discounted rate.  Care Dental Spa is a provider for a discounted plan called DentalPlans.com.  It is very affordable and it saves our patients money.  It's a win-win!

 

I hope this blog answered some of your questions regarding insurance.  If there is something that you would like us to blog about, please let us know.  We care about our patients' concerns and questions.  Our goal is to make you and your family patients for life. For more information please visit - https://www.caredentalspa.com