How to Find Out What Dental Insurance Covers

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  • Insurance companies offer different dental plans. What is covered depends on the plan you choose and the premium you pay. Many people are unaware of the kind of coverage they have under their policy and the treatment that is excluded. It is important to know what is covered, where and for how long.

    Review your dental plan. Begin by looking at the major dental clause. It should list all the major kinds of coverage offered. Rarely, you will find a plan that reads, “Pay all.” Such plans are usually very expensive and rarely available under a group plan or dental plan.

    Understand the limits on coverage. Some insurance companies provide a fixed amount of coverage on each of your medical bills irrespective of the duration of treatment or severity of the problem. Others provide a fixed to variable percentage of a pre-determined amount. Obviously, you cannot claim full reimbursement of the dentist’s fees. In effect, you will have to spend an additional amount from your pocket for the complete payment of dentist’s fees.

    Talk with your employer and learn about what kind of coverage is available on your existing company dental plan. You will be surprised to know about several exclusions and may have to settle for diminished service on treatments--employers typically choose the cheapest dental plan for their employees.

    Find out the demography of dentists you can choose for a particular treatment. PPO (Preferred Provider Organization) plans restrict (PPO MAKES LESS RESTRICTIVE) the options available to visit a dentist of your choice in your region.

    Learn about the basic aspects of stop loss and annual maximums in your plan. Ask your insurance agent if you have doubts. The annual maximum is the upper limit of the total expenses your insurance company will provide every year. If you are maxed out in three months, it means you have no dental insurance for the remaining nine months despite paying regular monthly, quarterly or annual premiums.

    Learn about the plan under which your policy falls. Typically, dental insurance is available in three formats: Traditional indemnity insurance plans, PPOs and Health Maintenance Organizations (HMOs). Each plan has its own limitations on coverage.

    Ask your local agent to clarify the UCR (Usual, Customary and Reasonable) terms. This is the term insurance companies use to standardize the fees.

    Ensure that you get correct information about what is included and not included in your dental plan.

    Consider buying a supplemental insurance for items and expense amounts not included in your primary dental insurance.

    Talk to friends and colleagues to sort out dental insurance issues.

    Seek an individual plan if you wish to be totally covered for all dental care costs. Remember, the premium will be substantially higher.

    Contact your agent representative before getting a dental treatment. Ask questions on coverage and extent of expenses. If the treatment is to cost you more than expected, get it in writing from the dentist. This will save you a lot of trouble in case of rejected or exceeded UCR claims.

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