If you are wondering if you should get a dental plan and have started shopping, sifting through the different plans and the fine print outlining what is covered and what is not is enough to confuse anyone. To make your head spin even more is the debate about whether dental insurance is “worth it”. Proponents and naysayers aside, New Look Dental wants to help clear up the confusion about what is covered, the benefits, types of plans, and how our practice works with dental insurance to help you decide.
What Is Dental Insurance?
A dental plan, also known as dental insurance, is simply a type of insurance that is geared towards dental health and a means to help pay a percentage of dental care costs.
Types and Coverage of Plans
The types of dental insurance plans are private or government subsidized. Many employers offer private coverage once a year at designated enrollment periods, but similar types of coverage are available to everyone. There are three main categories of dental insurance including DHMOs, (Dental Health Managed Organizations), Indemnity and PPO (Preferred Provider Network). Within that there are family, group and individual dental plans. With most of these you will pay a monthly premium that varies according to the type of plan.
DHMOs are based on contracts between dentists and dental insurance providers. The dentists involved are In-Network Providers who provide reduced service costs for a predetermined co-pay based on a set insurance fee schedule. With no annual maximum benefit and short or nonexistent waiting periods, DHMOs are ideal for those facing costly procedures. These plans may include semi-annual preventive care while some have limits for crowns, dentures, fillings and implants.
Indemnity plans usually permit patients to select their own dentists and are based on a graduated percentage scale of the dental service costs. These costs vary according to the duration you have had the policy and the type of service. These typically have waiting periods, deductibles, co-pays and annual limitations.
PPO means Participating Provider Network, and bears a similarity to DHMOs when using In-Network facilities. These organizations agree with third party administrators or insurers to offer lower or reduced rates to the patients of their clients (dentists, doctors, etc.) PPOs permit patients to receive services from Non-Participating or Out-of-Network Providers, with the balance of the fees falling to the patient. PPO also stands for Preferred Provider Organization, which is apropos at New Look Dental since PPOs are the preferred form of dental insurance we recommend and accept.
Dental Plan Coverage
As each plan is specific to the carrier and there are a variety plans to meet patient needs, it is important to read through the materials provided by the plan in question to determine what your plan covers and if there are timing requirements or other limitations. If you have a pre-existing condition, be sure to check if it is covered before you select a plan. Some coverage includes preventive care and emergencies while other plans may cover things like periodontal disease, partial dentures, a tooth bridge or a rider option for orthodontics.
Dental Insurance Pros & Cons
The main benefit is that the financial outlay of more serious dental issues, such as a root canal procedure, is minimized with most dental plans. Plus, preventive visits are typically covered, often at no additional cost.
People with healthy teeth mainly needing routine dental cleaning twice a year and once a year dental x ray may just break even with insurance, making it not worth the hassle. Those with a history of more extensive dental needs may find that they benefit more, however, they could max out the annual benefit limit having to pay the remaining costs out of pocket.
What We Offer
New Look Dental proudly takes all the top PPO plans:
- Delta Dental PPO
- Cigna PPO
- MetLife PPO
- Guardian PPO
- Blue Shield PPO
- Blue Cross PPO
- Aetna PPO
- Ameritas PPO
We also accept Denti-Cal, which is Medi-Cal Dental, a government dental insurance plan that people who are approved for Medi-Cal can apply for. Examples of services Denti-Cal covers:
- Dental exam
- Dental cleaning
- Dental dentures
- Dental filling
- Dental x ray
- Fluoride treatment
- Anterior (front) dental crowns
- Root canals for all teeth
- Certain dental care necessities
We also work with Care Credit credit plan to help people get their dental needs met.
How It Works
We have a fee schedule which lists the costs of all the services we offer. Each insurance company covers a different portion based on their own fee schedule that outlines the average rates for usual and customary services, based on the geographic area. They categorize benefits, procedures and services separately using the ADA 3-4 digit coding system. They break these categories down as follows:
- Basic + Preventative & Diagnostic procedures: Basic Cleanings, Preventative and Diagnostic exams and X-rays
- Major procedures: dental crowns, dentures and dental implants
- Basic procedures: fillings, endodontics, oral surgery, periodontics, with the last three often being policy dependent.
Before you sign up for dental insurance or your next appointment, review your plan or talk to your insurance company to verify details and ask the relevant questions.