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Dental care costs have risen significantly in the recent years in the US. This has placed Americans in a quandary over the decision of the purchase of a dental insurance policy. To resolve this issue, it is important that you gather the requisite information about various dental plans available. In fact it would be wise to do a comparative study of the features of all available dental insurance plans, whether bought through an employer or otherwise.
In almost every dental insurance plan, a ceiling exists on the maximum amount of insurance money that a dental insurance company will pay an insured person in one year. Unutilized insurance amount in a year out of this cap will lapse after the end of that year and cannot be utilized in the subsequent year. Generally, in most dental insurance plans, the yearly insurance cap is $1,000.
A potential insured person needs to find out whether under a dental insurance plan he/she is restricted to get dental care from a dentist who is a plan participant or if the insured can get a choice to get the same from a non-participant dentist too.
In case, such flexibility is not permissible under a dental insurance plan, a potential insured person needs to obtain a list of plan participating dentists who have clinics in the area in which he/she resides. This can help the individual concerned to take a decision whether one of them is one he/she can consider obtaining dental care from.
The individual concerned sometimes prefers to obtain dental care from his own dentist, who may be a non-participant. In that case, he/she will need to find out the extra costs that he/she will incur to get benefits of insurance under that plan. This will only be applicable in case the plan allows the insured to get dental care from a non-participant dentist.
Dental insurance companies use a fee guide to decide what they will pay to a plan participating dentist for different treatments or examinations received by an insured person under the plan. The fees are much lower than what will be payable to that dentist by a non-insured person for the same treatment or examination.
Dental insurance companies segregate the fee structure under three categories depending upon the type of dental treatment provided by the plan participating dentist to an insured under the plan.
These categories are named usual, customary, and reasonable. This fee structure is therefore known as the UCR fee structure. Any difference between a plan participating dentist’s normal fees for a non-insured and the UCR fee payable to that dentist by an insurer for the same treatment should be written off by the dentist and not charged to an insured person.
An insured person also needs to find out which treatments/examinations fall under which of the three dental treatment/procedure categories, preventive, basic/restorative, and major that an insurer has specified under a dental insurance plan.
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