Lets take a moment to step away and talk about non-teeth here. Lets talk about something you worry about more: money.
Dental insurance is complicated and tricky. Even with my years of experience dealing with it, its still difficult to know the in's and out's because each insurance plan is unique even within the same company (or carrier)! A lot of what I'm going to say is somewhat hush hush in the dental community. No one wants to take time to explain it to the patient because its complicated and it only discourages people from what the doctor is more concerned with: your dental health!
Lets start off with the basics. There are 3 types of plans that you will most likely encounter:
A PPO (Preferred Provider Organization) or DPO(Dental Plan Organization) is your typical insurance that most people are familiar with. They have an annual Maximum benefit limit which is typically between 1000-2000 dollars. They also have an annual deductible that you have to pay whenever you need anything more than a cleaning and exam. This is typically between 50 and 100 dollars.
Usually these plans will pay a particular fraction of your dental bill depending on what services you need. They typically pay more for smaller things like fillings and less for big ticket items like crowns. The remaining portion of the bill is called you "copay". The bottom line is they are trying to encourage you to get your cleanings and exams and discourage you from getting anything else. These copays are specially designed to discourage you from using your insurance so they can keep money in their pocket.
With that said, this is still the best type of insurance you can have among the three choices.
Here's some other facts that will play into effect:
- Many insurance plans will not pay for composite or white fillings in the back of the mouth (where most cavities occur). Insurance plans were first developed when there was mostly silver fillings and have resisted the increase in prices of more expensive white fillings. They will pay you and the dentist less which will result and higher than expected copays
- Many insurance plans have waiting periods before you can obtain services. They sometimes restrict only the bigger procedures like crowns but others may even restrict smaller ones such as extractions or fillings
- Many plans have what is called a "missing tooth clause" which basically states that they will not pay for any prosthesis for a tooth that was already missing when you enrolled in the plan. This includes bridges, implants and dentures (partial or full)
- Most insurance plans do not cover braces for adults so get them while you're young enough to get coverage!
- When you have a PPO insurance you can use it to see any doctor you choose. However there are some differences between doctors:
1) Some doctors have signed a contract with the insurance company which means they have to charge the fees that the insurance company dictates and they have to be imbursed but the insurance company directly.
2) Some doctors do not have contracts and have higher fees that the insurance expecting. So even though the insuance covers say 80%, they only cover 80% of whatever their fee for the area is. This could lead to large discrepancies. so if you're dental bill is large even though you have insurance you may have a doctor in this catagory
3) Some doctors will not accept your insurance directly paying them. This does not mean you cannot get coverage with them though. They often will send the claim to the insurance company and the insurance will send you a check. However, the dentist will expect the full fee up front this way. As a dentist this is actually the most fair way to handle things because often times the insurance company has lots of little clauses to deny coverage for certain things and we often have to eat that loss or send bills that never get paid. However, most people will not accept this and I understand.
