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The Four C’s of Dental Insurance

Admin • December 31, 2016
Most people have heard of the 4 C’s of diamond quality: cut, color, clarity and carat. But did you know there are 4 C’s to consider when purchasing dental insurance?

CATEGORY

Dental insurance comes in three varieties: DHMO, DPPO and Dental Indemnity plans.
  • DHMO (dental health maintenance organization) – This type of plan is usually the least expensive and restricts coverage to dental professionals within a limited network.
  • DPPO (dental preferred provider organization) – This type of plan typically allows patients to see dentists inside and outside the preferred network. Dentists within the network will usually be less expensive since they have an agreement with the insurance provider to accept a predetermined fee for procedures.
  • Dental Indemnity Plan – This fee-for-service dental plan allows a patient to see any dentist and typically picks up a percentage of the costs after deductibles and co-pays.

COVERAGE

It is important to consider your family’s dental needs when reviewing the actual coverage provided by your dental insurance plan. Some families may determine that they need minimal services, while others want extensive coverage. Be sure to obtain clear answers to these questions:
  • Does the plan cover diagnostic, preventive, and emergency services?
  • What routine treatment is covered by the plan?
  • What major dental care is covered by the plan?
  • What are the plan’s limitations and exclusions?
  • Who is eligible for coverage under the plan and when does coverage go into effect?

CHOICE

Many people want flexibility and control in selecting dental health care providers, procedures and medications. Find out who will make key decisions under your plan.
  • Does the plan let you choose your own dentist or are you restricted to dentists selected by the insurance company?
  • Who controls treatment decisions – you and your dentist or the dental plan? Some plans may require dentists to follow the “least expensive alternative treatment approach.”
  • Does the plan allow referrals to dental specialists?

CLAIMS

Managing dental insurance claims is perhaps the most confusing and frustrating aspect of receiving dental care. Many dental practices have eliminated on-site processing of dental claims, instead requiring patients to pay for care up front and then pursue the claim individually. It is important to find out the claims submission guidelines for your insurance plan.
  • Can claims be filed electronically?
  • What documentation is required?
  • How quickly will the claim be processed and paid?
  • How are disputes handled?
At Town & Country Dental, we accept an extensive list of insurance carriers and our experienced staff will process the claims. If you have any questions regarding how we work with your dental insurance plan, please call our office for assistance.
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