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How Dental Plans Work


Choosing a Dental Plan

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You've seen portraits everywhere­— in history books, in museums, even carved into a mountain. And often, you never see their smiles. Maybe that's because these individuals didn't have regular or preventive visits with their dentist. If you do, most likely your dentist understands your personal dental needs. He or she treats you individually to help you maintain your smile and keep your teeth for a lifetime. So when you are looking for dental insurance, make sure you can still see your own dentist. Many dental plans don't care about the doctor/patient relationship and might limit you to seeing one of the dentists in their network.

If seeing your own dentist is important to you, select a plan that gives you the freedom to choose your own dentist. You want to examine the services covered under your insurance plan. Some plans have coverage that is limited in the services it covers. Only you and your dentist know what you need to keep your smile looking it's best. Don't let insurance companies dictate what is best for you. Health decisions regarding your mouth need to be made between you and your dentist. So, keep these things in mind when looking for a dental plan. And remember to talk with your employer and insurance carrier if you have questions regarding the options or the services covered under the plan. Also know that some dental offices have trained staff that may be able to help you with your questions.

 
Evaluating Your Plan

It’s important that you spend some time looking at the details and the costs of a dental plan before making your purchase. Here are a few questions you need to ask:

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  • Can I go to the dentist I choose to see?
  • Can I see a specialist anytime my dentist or I believe it is necessary?
  • Am I directly involved, along with my dentist, in choosing the best course of treatment to fit my specific needs?
  • Is there a broad scope of services covered by this dental plan?

If you are unable to answer “yes” to all of the above questions, then you probably are looking at a restricted plan that may limit who you see and procedures you can have done. Many dentists choose not to participate in these types of plans because they limit the options he/she can provide for you. For many dentists, “the quality of care is not a variable.” They choose not to participate with an insurance plan in order to maintain a high standard of care for their patients.

You should have the freedom to choose your own dentist. You should have the ability to see a specialist if needed. And you should expect the highest quality of individualized care from your dentist. The dental health decisions you make need to be a joint collaboration between you and your dentist only. Making health decisions based on insurance coverage often results in compromised care and ultimately leads to negative consequences for your teeth.

Trust and good faith are an integral component of the dentist/patient relationship. The relationship you have with your dentist is as important to your oral health as brushing and flossing. Dentists who are members of the New Hampshire Dental Society believe in the highest quality of care for their patients and believe that the integrity of the patient/dentist relationship is sacrosanct.

 
How Dental Fees Are Set

If you are like most people, you probably don’t pay much attention to your dental benefit plan. The book outlining the details of your plan can be cumbersome and difficult to understand. Here are a few things you need to know about a dental plan.

A dental plan is a contract between your employer and the insurance company to pay a predetermined portion of your dental care. Some plans outline what dental services your employer has agreed to pay and which dentists you can see.

It is important to read and understand your benefit plan summary. Keep in mind, your insurance plan might not adequately provide for all of your dental treatment needs. Only you and your dentist can decide what treatment is best for you.

How are my dentists’ fees determined?

Your dentist determines a fee for each procedure performed. These fees frequently vary between dental offices due to varying overhead costs. Factors affecting the differing fees include: staff costs, office location expenses, state-­of-­the-­art equipment, modern dental materials, current infection control measures, and continuing education to ensure that the dental team is up to date on the latest techniques.

How are my dental benefits determined?

Your benefits are determined by the contract your employer has set up with the insurance company. Your employer pays the insurance company a specific premium; the insurance company uses the monies collected to pay for your care. Usually, the higher the premium your employer pays, the better the coverage and the less you will be expected to pay out of your pocket.

When you are looking at the description of your dental plan, check carefully to see which services will be fully covered by your insurance and which ones will require you to pay a portion, often a percentage, of the “usual, customary, and reasonable fee.”

Most insurance companies use a “usually, customary and reasonable” (UCR) fee schedule to decide what portion of the fee they will pay for. This UCR fee is a predetermined fee and varies greatly among the different insurance companies. In addition, be aware that these fees are often negotiated between your employer’s plan administrator and the insurance company. Because the insurance company sets the fee limits, they may or may not reflect the actual costs of dental care in your area. There are no standards for determining UCR fees. So the percentage of the fee you pay will vary depending on the difference between your dentist’s fees and the UCR.

 
Finding Dental Plans

If you are looking for a list of dental plans or need more information on insurance companies, you may wish to contact the State of New Hampshire Insurance Department at (603) 271-­2261 or visit www.nh.gov/insurance/consumers/index.htm

 


NH Dental Society • 23 South State St., Concord NH 03301 • Ph. (603) 225-5961 • Fx. (603) 226-4880