Choosing the Right Insurance

The last post introduced different insurance plans that most companies offer. Here we will discuss what these mean for you, define some of the terminology, and provide sample treatment costs.

As I have mentioned before, all insurance companies work differently. This is very important to know and realize how it could affect you. You should not sign up for the first plan you find. Shop around because you won’t know what each company offers and how they are diverse until you do some research. One company may offer more benefits for reconstructive dentistry, but may cost more. If you do not need multiple crowns, bridges, implants, dentures, etc. this plan would not be necessary for you to spend the extra money on it. It would be more practical to choose a plan that best suites your needs of semi-annual check ups and routine treatments, such as fillings.

In all of the plans, the insurance company is going to pay the least amount possible, since they too are a business and trying to make money. They typically pay the lesser of the following: their maximum plan limit, the dentist's filed fee, the actual charged fee, or the set amount for a procedure outlined elsewhere in their contract. These will depend on your specific plan of what they will pay so it is important to know all of the terms and conditions for each plan, as the company may not come right out and tell you. You could end up paying a lot of money out of pocket if you don't carefully go through the documents.

As Jeffery noted in a previous comment, most companies only pay for two trips to the dentist in a year. From the research I've found, this seems to be the case on the cheaper, more basic plans. Many plans will cover the expenses needed to determine the problem or best treatment. Those can include two cleanings a year, as recommended by the dentist, x-ray films, and topical applications of fluoride solutions. These all change between plans and other procedures may be included, so read carefully when searching for your own plan. Many will also include amalgam and synthetic fillings (silver and plastic restorations, respectively) and denture or other partial restorations.

Some companies have a policy where they only pay for the alternative treatment. This is when two procedures are suggested to fix a problem and they will only pay for the lesser of the two, even if that means incurring costs later on. An example of this would be to continue replacing a broken crown instead of extracting the tooth and putting in a bridge. This seems to be the most cost efficient for the insurance, since they are only dealing with the costs incurred right now, and not as much with the future.

There are plans where you have a set deductible that you have to pay before they will cover the rest of your treatment. A deductible is the amount you pay once a year before the insurance company will start paying. Depending upon your deductible and the cost of treatment, you may end up paying for part or all of your fist visit, but the rest of your trips to the dentist the rest of the year will be covered by the insurance company. Other plans will be designed for you to pay a percentage of each bill. Still other plans will have you pay both the deductible and a percentage of each trip. Co-pay is when you have to pay a certain dollar amount upon each of your visits. This is typical for people on Medicaid.

Here are some examples of what companies will pay:
Alflac pays 50% of the bill, regardless of what you are getting done.
Blue Cross Blue Shield will cover 100% of preventative procedures, 80% of restorative treatment, and 50-60% of major treatment.

Preventative procedures include cleanings (prophylax) and x-ray exams. Restorative procedures include fillings, re-cements, and pins for tooth support or crowns. Major treatment includes braces, root canals, reconstructive (bridges and crowns) and implants. Implants are usually only covered when the dentist proves that the patient can not wear a normal partial and they do not usually cover implants for cosmetic reasons.

Pre-estimates are typically sent to the insurance by the dentist so the patient will know how much the insurance will cover and how much they will be responsible for paying. This is helpful for the patient when trying to decide between two possible procedures. Pre-estimates are usually done for any major treatment such as crowns, bridges, dentures, or partials.

When insured through a company, the logistics are worked out between the employer and the insurance company. These plans vary greatly as well; some employees have to pay $5-10 each month while others from a different company could be paying $50-70 per month. If you are insured individually, because your company does not offer dental insurance, you work for yourself, you are retired etc., you will usually pay much more than an employee with a company.

The prices below are for basic dental procedures, provided by Dr. Thomas Kiefer’s office. These on the cheaper end of the spectrum of what dentists usually charge.
Cleaning and x-ray exam: $78 uninsured; $101 insured.
Amalgam fillings (silver): $58-80 uninsured; $64-98 insured.
Synthetic fillings (tooth colored): $60-88 uninsured; $74-108 insured.
There is a price range on the fillings because it depends upon the number of tooth surfaces being repaired.

Taking all of this information into account, you can hopefully make a better, educated decision on whether insurance is right for you and what plan best fits your needs. If at any time you no longer like the plan you are on, you can let your insurance know and they can drop you at any time. (Once again, re-read your terms and conditions so you don’t incur more costs.)

Information provided by Kellie at Dr. Kiefer's office, Delta Dental and DentalInsurance.com.