Dental Insurance Information

Dental Insurance Information

Learn More About Dental Insurance

Some dental insurance plans encourage you or your dentist to submit a treatment proposal to the plan administrator before receiving treatment. After review, the plan administrator may determine: the patient’s eligibility; the eligibility period; services covered; the patient’s required co-payment; and the maximum limitation. Some plans require predetermination for treatment exceeding a specified dollar amount. This process is also known as preauthorization, pre-certification, pretreatment review, or prior authorization. To help contain costs, your dental insurance plan may limit benefits by the number of procedures and/or dollar amount in a given year. In most cases, particularly if you’ve been getting regular preventive care, these limitations allow for adequate coverage. By knowing in advance what and how much the plan allows, you and your dentist can plan treatment that will minimize out-of-pocket expenses while maximizing compensation offered by your benefits plan.

Many dental insurance plans provide a peer review mechanism through which disputes between third parties, patients, and dentists can be resolved, eliminating many costly court cases. Peer review is established to ensure fairness, individual case consideration, and a thorough examination of records, treatment procedures, and results. Most disputes can be resolved satisfactorily for all parties.

What To Consider When Searching For Dental Insurance Plan

1. Does the plan give you the freedom to choose your own dentist or are you restricted to a panel of dentists selected by the insurance.
2. Who controls treatment decisions
3. Does the plan cover diagnostic, preventive, and emergency services? If so, to what extent?
4. What are the plan’s limitations?
5. Can you see the dentist when you need to and schedule appointment times convenient for you?
Final Thoughts on Dental Insurance
If you are covered under two dental benefits plans, notify the administrator or carrier of your primary plan about your dual coverage status. Insurance plan benefits coordination can help protect your rights and maximize your entitled benefits. In some cases you may be assured full coverage where plan benefits overlap, and receive a benefit from one plan where the other plan lists an exclusion. It may be wise to choose a plan that imposes dollar or service limitations, rather than one that excludes categories of service. By doing so, you can receive the care that’s best for you and actively participate with the dentist in the development of treatment plans that give the most and highest quality care. To help stretch each dental insurance dollar, most plans provide patients and purchasers with special administrative services. Find out if your plan provides the following mechanisms to help you budget, analyze, and dispute, if necessary, the costs of dental care.



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