Dental Insurance

1. Dental Insurance Plans – Who Pays The Dentist?
2. What percentage of your dental bills does your dental insurance company pay ?
3. Is your dental plan an indemnity a capitation or a direct reimbursement plan?

What do they mean in simple plain English. Let’s find out…

Dental plans are of three types based on the compensation and treatment provided.

Indemnity Dental Plans. In this type of California dental plan the dentist is paid fee for
service. The dental plan provider, pays -% of the dentist’s fee and remaining is paid by you.
The dental insurance company will only pay after you have started paying the premiums, and the
range of services can also be restricted.

Capitation Plans The patient gets comprehensive coverage under this type of the California dental insurance. A good example is a DHMO. The dentists are paid on per patient basis every month. Some amount will have to be paid by you, the patient for each visit you make to the dental care provider.

Direct Reimbursement Plans Under this type of California dental insurance, the patient’s employer reimburses a percentage of the employee for his/family’s dental treatment costs from its own funds. The employee usually has a choice of dentist and type of treatment to be provided to him/family.

Choose a Dental plan that’s right for your needs.

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Who chooses your dentist?

Do you get to choose your dentist under your dental plan?

Or are you constrained to go a dentist chosen by your dental insurance company?

Dental plans have different options for choosing a dentist.

Some dental plans allow you the freedom to choose your own dentist while others limit your choice for lower rates.

These two alternatives are called the open and closed panel dental plans.

Open Panel. This type of an American dental plan allows patients to go to a dentist of their choice. Similarly any dentist has the choice to accept or refuse to treat patients enrolled in this type dental insurance plan. Open panel plans often are described as freedom of choice plans.

Closed Panel. This type of American dental plan allows patients to choose only from a limited number of dentists who have contracted with the dental insurance company.

Closed panel plans are again of two types

Preferred Provider Organization (PPO) – The participating dentist provides service at less than
his usual fee to the patients covered by this type of american dental plan.

Exclusive Provider Organization (EPO) – Some patients can see a group of dentists under this
American dental plan. . An EPO contracts with a limited number of practitioners and access to
necessary specialized care may be restricted. The EPO may also limit the amount of services that a
patient can receive in a given calendar year.

If you prefer going to your trusted dental care provider then choose a open panel plan, but read the fine print to see that emergency and routines tests are covered. This might be expensive.

Strike a balance, a better option might be to choose a dental insurance that has a large number of participating dentists from whom you can select one.

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