Dental Insurance

By Anna Lynn C. Sibal

Dental insurance is a form of protection that an individual or group pays for in the event that the need for dental care arises for that individual or group. Basically, the insured party pays a premium to the provider of the dental insurance, and the provider covers the expenses the insured party incurs whenever he or she visits a dentist for whatever dental care that the insured party requires. Ideally, dental insurance providers cover the entirety of the these expenses, but in reality, only around 80% is paid up, forcing the insured party to settle the remaining cost out of his or her own pocket.

Most individuals or families get their dental insurance as part of the benefits package employers provide their employees. It is not a strange occurrence, however, to hear of an employer cutting down operational expenses of his or her company by slashing items from the employees’ benefits package. Dental insurance is usually the first to go.

There are two types of dental insurance currently available in the US. A dental insurance plan usually falls under a Preferred Provider Organization or a Health Maintenance Organization.

In a dental insurance falling under a Preferred Provider Organization (PPO), the insurance provider goes into negotiation with dentists to make arrangements for fees and payments schedule. In return, the dentists will agree to be placed in a list of preferred providers of dental care for the members of the insurance provider.

Dental care covered by insurance providers under a PPO includes preventive care (such as cleanings, check-ups, x-rays, fluoride treatments and dental sealants), basic care (fillings, extractions and root canal therapy), as well as major care (gum care, permanent bridgework, dentures and crowns).

This type of dental insurance is good in that it can truly help insured dental patients cover the cost of treatment. However, like any insurance plan, PPO dental insurance has its faults and limitations. Insured parties pay a premium, but insurance providers only pay a certain portion of the actual dental care expenses incurred. This brings the insured person to pay up the difference by him- or herself.

Another thing to bear in mind with PPO dental insurance is that the insured person can only avail of dental care benefits up to a certain value for every year of membership with the insurance provider. Once this ceiling is reached, the insured person will have to pay whatever amount in excess of this cap. It is not cumulative.

If PPO dental insurance can be satisfactory in most cases, the same cannot be said of dental insurance falling under a Health Maintenance Organization. HMO dental insurance plans are getting a lot of flak lately, mainly because the fees they pay their accredited dentists is very low compared to the dentist’s actual workload. These fees are reported to be barely enough to pay for the dentist’s overhead costs. This, in turn, greatly affects the kind of service dentists operating under an HMO dental insurance give their patients. The care dental patients get under an HMO dental insurance plan is insubstantial at best.

In choosing a dental plan, it is important for the applicant to understand every provision in the policy to avoid confusion. It is also important to keep a copy of this policy, the brochures, the receipts, the correspondences and all other documentation received and exchanged with the dental insurance provider, in case the need for clarification arises.