Dental Insurance – Advantages and Disadvantages

As a consumer, you have access to a wide variety of dental insurance plans, each of which has particular strengths and weaknesses. Indeed, sorting through the hundreds of available options can be a daunting task. Not only are there many dental insurance companies serving a particular area, but there are also dental discount plans that offer cheaper rates, while not having to adhere to the strict regulations required of dental insurance plans.

Dental PPO

On a Dental PPO Plan, you are required to choose your dentist from a network of dental clinics that your particular plan contracts at a lower rate. Although you can choose a dentist outside of the network, you will typically pay more for your services. Some plans offer discounts on basic services at non-networked dentists, while others require you to pay the full rate.

Generally, on a PPO Plan, you will only need to pay the portion of the fee that’s not covered by your plan, rather than paying the full amount up front and being reimbursed later. These plans also require you to pay a deductible for all services and cap dental payments at a certain amount per year.

Prepaid Plans

A prepaid plan requires that you choose one dental clinic to take care of all your dental health needs. If you need to see a dental specialist, you will likely need to get approval from your dental insurance company prior to receiving care.

Rather than a deductible, you typically pay a co-pay, or a fixed rate, for any given dental service. Some preventive and diagnostic services are usually available completely free of charge. If you don’t have any specialized dental needs, a prepaid plan is usually the most affordable dental insurance option.

Fee-for-Service Plans

A fee-for-service plan gives you the greatest choice of dentists. It follows that these plans are also more expensive than any of the other dental insurance options.

On a fee-for-service or indemnity plan, your payments are usually capped at a certain amount per year, and you are required to pay a minimum deductible. Payments vary by procedure, with preventive and diagnostic procedures typically covered at 80% and crowns and other major operations covered at a lower rate, such as 50%.

Discount Dental Plans

You may have heard of discount dental plans. These are plans that are gaining in popularity because they typically offer deep discounts compared to fee-for-service plans. It’s important to realize, however, that these are not dental insurance plans and are not subject to the same regulations.

A discount plan typically offers a low monthly or annual fee for basic preventative and diagnostic dental services. These plans tend to appeal to younger dental patients because there is no paper work involved, and there are no deductibles or yearly limits.

Each person’s dental needs are unique, so there is no dental plan that is right for everyone. The most important criteria is usually your level of comfort with a particular dentist. Once you find a dentist you like, you can usually work with them to enroll in a dental insurance or discount plan that’s right for your teeth and your wallet.

What Your Dental Insurance Will Cover

Patients and dentists both experience some disappointment when insurance will not cover some procedures. However, it is important to remember that the decision-making about dental health belongs to the patient and the dentist, not a “third party”.

“Frequency limitations” will determine how often a particular service is covered (mentioned in the previous post). In the case of a filling, most insurance plans will limit the number of times it will pay for a filling on a surface of a tooth. Every tooth has 5 surfaces; one faces the front of the mouth, one faces the back, one faces the outside, one faces the inside, the last one is the top of the tooth. Once a surface gets a cavity, and is filled, the insurance company will keep track of that tooth number and the surface the filling covered. If the patient is unlucky enough to get another cavity and need another filling in that tooth, and one of those previously filled surfaces is involved, the insurance will not pay for that surface which was previously involved. It does not matter that a new cavity is present, and posing danger to that tooth. This is where the partnership between the dentist and the patient comes into play; a decision is made about keeping teeth healthy. In this particular case, an additional discussion will take place regarding better preventive practices (more on this in another post). The frequency limits that are most common for fillings are 1 to 2 years.

Dental crowns (caps) and bridges also have frequency limits set by insurance plans. Once a tooth has been crowned (individually or as a part of a bridge), coverage for another crown will not be provided for a number of years. There are times when a patient will get a cavity right at the seam, or margin where the tooth meets the crown. Most times, the cavity develops deep under the crown, and a new crown is needed to save the tooth. However, if the insurance plan paid for a crown too recently, it will deny payment for a new crown, even though it is necessary to save that tooth. Here, again is the importance of the partnership between the dentist and the patient; a decision needs to be made about keeping teeth healthy. In this case also, a discussion will take place regarding better preventive practices. The frequency limits that are most common for crowns/bridges are between 2 to 10 years.

When you experience some disappointment regarding a “denied dental claim” it will be important to remember that you and your dentist are partners in deciding your dental future. After all, what else can impact your life as much regarding your enjoyment of meals, your conversations, your smile and, don’t forget, your kiss!

Restorative Dental Treatments: Dental Implant, Crown And Bridges

Apparently, dental services account for the largest portion of benefit payments by private health insurers (the Australian government’s Department of Health reports that dental services accounted for 51% of the total benefit payment by private health insurers in 2011 – 2012, which amounted to $1.79 billion). Restorative dental treatments, in particular, are quite costly yet vital for good oral health.

The different types of restorative dental treatments include: dental implant, crown and bridges. These forms of treatment help to restore your natural smile while preventing oral health issues in the future. This is done by restoring damaged teeth or replacing missing teeth.

Dental Implants

If you have missing teeth, dental implants would be your best choice for restoring a full set of teeth. In this treatment, the metal anchor of a dental implant is inserted deep into your jaw bone. Thereafter, a false tooth is inserted onto it, producing a firm tooth that looks like the natural one.

Crowns

Of all the restorative dental treatments, as well as all other dental treatments, crowns are the most costly (the Australian government’s Department of Health reports that the average dental charge for crowns, in privately insured Australians, was $1,397.98 during 2012). This is because such a restorative treatment requires advanced expertise, special material and equipment.

A crown is basically a cap shaped in the form of a tooth. It is placed over natural teeth to provide protection for damaged teeth. Crowns will not only look similar to natural teeth, but are also equally as hard.

There are several instances in which you may need a crown. The International Dental Foundation identifies some of the signs that you should look out for:

(i) Cracked teeth would normally require a crown. If your teeth hurt while biting, you probably have a cracked tooth. This requires restorative treatment, since the crack will not heal.

(ii) The extent of a crack will also determine the extent of treatment required. Full-coverage crowns would be necessary in cases of vertical cracks reaching the gum line. However, cracks extending below the gum line would need crown lengthening or extra treatment, such as root canal therapy or even extraction. Following extraction, a dental implant may be applied.

(iii) If you have a discolored tooth filling, a crown may be inserted, simply to conceal such discoloration.

(iv) A combination of crown and bridges would be inserted for the purpose of holding bridges or dentures firmly in place.

(v) A crown may be necessary in case you have a large tooth filling. This is because the filling may lead to cracking of your tooth; hence a crown would help protect your tooth.

(vi) You should also differentiate between a crack and a craze. Craze lines are simply stress lines, which normally don’t require a crown, since they don’t affect your tooth’s structural integrity. This may just require whitening. However, deeply stained or very long craze lines could be an indication of developing cracks. Your dentist is able to identify such subtle differences and recommend the appropriate treatment.

Bridges

Cases of missing teeth are generally treated by inserting dental bridges. This is useful in covering the gaps between teeth. Such treatment is not only useful in improving your appearance, but also keeping the other teeth in place.