If you are looking for a dental insurance plan for yourself, your family, and / or your business, check with your insurance agent or look in your local Yellow Pages under "Insurance." You can also call the American Dental Association's Department of Public Information and Education at 312-440-2593 to request a copy of Selecting a Dental Benefits Plan. (There is no charge for single copies.)
Before enrolling in any dental plan, be sure you understand how the program works, which procedures are covered, and what costs are involved. Each type of insurance has advantages and disadvantages of which you should be aware.
The HMO usually costs the insured less on a monthly basis. With an HMO, the insurance company contracts with dental or medical offices in various areas. The insured selects one of these offices and may seek services only at that location. To visit another location, the insured must contact the insurance company to make necessary arrangements. The contracted provider receives a set amount of money per insured person. Basic services such as exams, cleanings, and fillings are provided at no charge to the insured; however, more extensive treatments such as crowns and bridges have a set copayment that the insured must pay. The disadvantage of the HMO is that the copayments are usually low, and the provider often prefers not telling the patient about some needed treatments since he or she would lose money. If you require only preventive care and not extensive treatment, this is an adequate type of insurance.
With PPI, the insured also chooses doctors from a list, but the doctors under contract usually receive a certain prearranged percentage (usually 70 percent) of their usual and customary rate. Under this arrangement, you are more likely to receive the proper diagnoses and treatment for extensive problems, since the provider receives adequate compensation. The premiums for PPI are more than those for an HMO but less than those for indemnity insurance.
With indemnity insurance, you choose the doctor you will visit. Your insurance contract specifies the percentage of the doctor's usual and customary rate (UCR) that the insurance company will pay for each treatment. For example, 100 percent of the exams, cleanings, and x-rays might be covered; 80 percent of the fees for fillings; and 50 percent of the doctor's usual fee for crowns, dentures, and bridges. With this type of insurance, you have a maximum dollar amount you can spend on treatment per year, and you have a deductible. Indemnity insurance is more expensive, but the advantage is that you can choose any doctor you want, and you will receive all needed treatment.
Dentists who accept only indemnity insurance are more likely to offer payment plans. Some dentists will allow you to charge their services to a major credit card. If your bill is large, some dentists will be willing to work out a schedule of weekly or monthly payments until the bill is paid in full. If paying the bill is a concern for you, be sure to discuss payment options before beginning treatment.
Choosing a dentist is not simply a matter of walking into the office nearest you. You want safe, professional, caring treatment at a reasonable cost, and you can find it if you do your homework.
From The Complete Book of Dental Remedies by Flora Parsa Stay, DDS, ©1996. Published by Avery Publishing, New York. For personal use only; neither the digital nor printed copy may be copied or sold. Reproduced by permission.