You pay monthly premiums for your dental insurance so it’s only logical that you expect to reap the benefits of this expense. Yet, so many Americans are missing out because they fail to maximize the value of their dental insurance plan. With terms like HMO, PPO, out-of-network, and in-network, it’s perhaps not surprising that people will just forget about their plan until it’s time to renew it the following year.
A good dentist can work with you to help you leverage your plan to your advantage. However, it’s important if you to have a robust understanding of the plan’s workings. It’s when armed with the right knowledge that you and your dentist can form a useful partnership that can only benefit your dental health and care. Don’t settle for the bare minimum. Make the most of your dental insurance plan with these tips.
Table of Contents
1. Understand the Plan
There are two main types of dental plans—Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). With a HMO, you have to choose a dentist within your network who’ll be responsible for the majority of your dental care needs. You’ll be charged a fairly low amount as copays for dental procedures and dental visits. There’s usually no cover for out-of-network dentist visits. With PPO, you can see both in-network and out-of-network dentists but the coverage is less expensive when you are in-network.
Once you’ve decided on the plan that’s best for you, take time to read as much as you can on it. It’s primarily your responsibility and not that of the insurance company or dentist to ensure that you are getting the services you pay for. The good thing is that the availability of healthcare plan information online is at the highest it’s ever been.
It may be boring and time-consuming to read, but this knowledge is not just crucial in helping you find an affordable, suitable, high-quality plan. It is also the best foundation for maximizing all the benefits your dental insurance plan has to offer. The good thing is that insurers are required by law to provide their clients with a description of the plan’s benefits.
Study the plan’s limitations, provisions, coverage and exclusions. The more you know, the less likely you will endure claim denials and unexpected bills.
2. Attend Regular Checkups
A dental insurance plan is not something you should reserve for emergencies only. Regular visits to the dentist for preventative care are useful in maximizing your plan’s benefits. Not only does this ensure any dental problems are addressed early, but it also gives you a chance to develop a close working relationship with the dentist.
3. Stay In-Network
PPO plans will negotiate fee reductions with participating providers. The providers agree to an itemized fee schedule that details the fee reductions on the price of treatment even before the insurance plan payments kick in. So even when a treatment is not necessarily covered by your plan, the in-network dentist has likely agreed to a reduction in the total fee, something you are entitled to. Covered services will usually qualify for fee reductions of 10-35% when you visit an in-network provider.
HMO plans do not pay any claim for a service provided by a non-network dentist or oral surgeon. Make sure you understand your obligations as far as the plan you are on goes and, if need be, obtain the required referrals.
4. Read the Explanation of Benefits (EOB)
The EOB statement is given to the patient and dentist each time a dental care claim is paid or denied. Take time to read and understand it. Thereafter, compare it with the itemized receipt provided by the dentist. Ensure that the plan has paid the claim correctly. If there are charges that were denied or unpaid yet you cannot see the rationale for it, don’t hesitate to find out why.
Do not pay for a service skipped by the insurance company before your first call to find out why the fee was denied and whether there’s anything you can do to have it paid.
Dental insurance is intended to help patients manage the cost of maintaining dental health. You took up dental insurance for this reason and you deserve to get the full service that you pay for. Utilize these tips and you will see your dental insurance plan as an asset, not a liability.
