Dental Insurances

Selecting or Changing Your Dental Plan

Prior to choosing or changing your dental insurance plan there are some important factors to consider. First, some plans do not allow for choice of dentist, but rather provide a list of limited and approved dentists. Please be aware choosing a dentist from a list is not freedom of choice. Therefore, if we are not on your approved list please ask why we have not elected to participate.

What does dental insurance cover?

It is essential to remember that dental insurance plans are most frequently a business arrangement between the insurance company and an employer. Furthermore, plans are typically established to assist or pay a portion of dental care expenses rather than pay the full amount of dental care needed. Dental plans may discourage certain treatments, for instance, dental sealants are often not covered. Your dentist may however recommend this treatment and in the case of sealants this treatment may prevent tooth decay and hence save you money on future treatments. Therefore, it is essential to know what your plan covers and what its limitations. Often plans do not cover recommended treatments, this does not however mean that the treatment is not necessary or beneficial for your overall oral health. Please do not hesitate to ask your dentist regarding the specifics of treatments and what is covered versus what is necessary.

Pre-existing dental conditions are not covered by all insurance plans and some plans may not cover treatments such as dental implants, referrals to specialists and other dental needs. Therefore, you and your dentist may agree on an appropriate and preferred treatment method for your dental condition and your dental plan may only pay a portion of that treatment or not cover it at all. Dental plans may also only pay a portion of the treatment that is deemed the least expensive alternative treatment (LEAT). It is important to remember the LEAT is determined by the insurance company and may not always be your first choice or the best option for your oral health.

The terms “usual, customary, and reasonable” (UCR) may be used to determine the portion of your dental treatment that your insurance plan will cover. The UCR levels are determined by administrators at the insurance companies and may differ greatly amongst plans. Therefore, depending on your plan your coverage of varying dental treatments may vary significantly in what portion is covered and what portion the patient is expected to pay.

Questions to consider prior to selecting a new dental insurance plan

• Will I be able to choose my own dentists or use the dentist I currently see?
• Who determines the type of treatment that I will be provided?
• Can myself and my dentist choose the treatments I elect to receive?
• Does the plan cover diagnostic, preventive and emergency services?
• Does the plan cover preventive services such as sealants and fluoride treatments, which may save me money in the future?
• Does the plan cover full-mouth x-rays?
• What type of routine dental care is covered?
• Does the plan cover crowns and bridges, braces, root canals, oral surgery and treatment of periodontal diseases?
• What major dental care is covered, dentures, implants or treatment for temporomandibular disorders?
• Will the plan allow me to utilize specialist when needed with a referral? If so, will I have the freedom to choose which specialists I choose?
• Will the plan cover needed emergency treatment? What provisions are made for emergency care when I am away from home?

• Does the plan requires monthly premiums?
• What percentage of the monthly premium monies goes to actual care and not to overhead or administration?

Insurance Benefit Gaps

Patients often are surprised to find that their insurance benefits do not cover all the treatment their dentist recommends. Dental insurance benefits for the most part have remained at the same level for more than two decades, leaving patients to pick up any added costs out-of-pocket. In recent years, payment options have emerged to help patients bridge the gap between what their insurance covers and the total cost of care. Boulder Dental Center will accept cash, personal checks or major credit cared, Boulder Dental Center also offers outside monthly financing program. For more information, an online application go to : Care Credit, Chase Health Advance and Springstone Financial.