Direct Reimbursement Plans
In direct reimbursement plans, your employer reimburses you directly for all or part of your dental treatment. Usually, you can see the dentist of your choice, and all types of treatment are covered.
Preferred Provider Organization Plans
Also called dental health maintenance organizations or HMOs, the preferred provider organization plan, allows you to choose any dentist, but the plan will pay a higher percentage of the fees if you choose one from a specific network of dentists who have agreed to discount their fees to be part of the plan.
In this plan, whether you visit the dentist or not, it pays participating dentists a set for each patient enrolled in the plan.
The most common insurance programs are indemnity or UCR plans. The initials UCR stand for “usual, customary, and reasonable”. In these plans, you may find a dentist of your choice, and the dentist is paid on a traditional fee-for-service basis.
You or your employer pays monthly premiums to the insurance company, and then the insurance plan pays 20 to 50 percent of their UCR fees, leaving you to pay 20 to 50 percent of the remaining fees that the insurance plan’s UCR fees don’t cover.
These UCR fees are usually not representative of local dentists’ fees. They are often fees arbitrarily set by the insurance company. In fact, it’s not usual for the same insurance company to pay different UCR fees to the same dental office, depending on the plan purchased by different employers.
For the same reason, different insurance companies’ dental plans often have a different UCR for the same geographical area and for the same group of dentists.
The Choice is Yours
It’s very common for patients to choose dental treatments that their dental insurance plans won’t fully pay for.
Dental plans generally set which dental services will be covered and which will not. Many dental plans cover only lower quality materials and services, and these may not be the best treatment choice for you and your family.
Most insurance plans often exclude new treatments that they label as “discretionary,” even common treatments such as implants, porcelain veneers, white fillings, bonding, and whitening.
In addition, dental insurance coverage maximums just haven’t kept up with the times. Back in 1060, a typical annual maximum was one thousand dollars. Forty years later it still sits at approximately one thousand dollars, despite inflation and cost of living increases. To stay up with inflation, that one thousand dollars in 1960 would have had no increase to $5,816 dollars today.
For these reasons, you have a choice to make when it comes to your dental care. In many cases, your insurance plan may want you to consider only the least expensive dental procedures, but we believe that you should be able to choose the best dental treatment and materials for you and your family.