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Lot of you may have some form of dental
benefit coverage but may not be using it to it's
maximum for various reasons, One of which is not
understanding your plan fully. You should know
how your plan is designed and use it properly as
oral health plays an important role in overall
health of your body. American Dental
Association (ADA)
recommends having oral checkup and prophylaxis
at least twice a year or more depending on the
overall health of your gums and teeth to prevent
severe dental diseases. Two of these Hygiene
visits are paid in full by most of the plans and
everyone should be taking advantage of this part
of the dental insurance coverage. To make the
best decision for you and your family, you
should understand exactly how the different
kinds of dental benefit plans work and how they
derive your cost savings. Dental benefit plans
are designed in many different ways, the most
common designs can be grouped into the following
categories: Direct Reimbursement programs
reimburse patients a percentage of the dollar
amount spent on dental care, regardless of
treatment category. This method allows the
patients to go to the dentist of their choice.
"Usual, Customary and Reasonable" (UCR)
programs usually allow patients to go to the
dentist of their choice. These plans pay a set
percentage of the dentist's fee or the plan
administrator's "reasonable" or "customary" fee
limit, whichever is less.
Schedule of Allowance programs
determine a list of covered services with an
assigned dollar amount. That dollar amount
represents just how much the plan will pay for
those services that are covered. The patient
pays the difference. Preferred Provider
Organization (PPO) programs are plans under
which contracting dentists agree to discount
their fees as a financial incentive for patients
to select their practices. If the patient's
dentist of choice does not participate in the
plan, the patient will have a reduction or
complete loss of benefits. Capitation
programs pay contracted dentists a fixed
amount (usually on a monthly basis) per enrolled
family or patient. In return, the dentists agree
to provide specific types of treatment to the
patients at no charge (for some treatments there
may be a patient co-payment). You may find
your dentist recommending treatment that your
plan will not pay for in some cases which does
not mean the treatment is not necessary. It is
common for dental plans to exclude treatment
that is covered under the company's medical
plan. Some plans also exclude necessary dental
treatment such as sealants, pre-existing
conditions, adult orthodontics, specialist
referrals and other dental needs. You need to be
aware of the exclusions and limitations but
should not let those factors determine your
treatment decisions. Some plans will only
provide the level of benefit allowed for the
least expensive way to treat a dental need,
regardless of the decision made by you and your
dentist as to the best treatment, for example
your dentist may recommend a crown for a tooth
for more strength, support and prevention
against fracture but your plan only allows for a
large filling. You should base treatment
decisions on your dental needs, not on your
dental benefit plan in these cases. If you
have more questions regarding your dental
benefits and need help understanding the
breakdown of allowances, please feel free to
call our office at 510-796-1656 or write us at
hp_dds@yahoo.com and we'll be glad to assist
you to use your dental insurance at it's maximum
extent.
Aetna Health Plans
Aetna Life
Aetna US Healthcare
Bluecross
California
BlueShield
Association
Cigna
Delta Dental
Guardian
MetLife
Prudential
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