Getting a root canal done is enough pain in itself, but having to pay for it may be an additional source of pain. Dental work can be expensive. Most dental insurance plans will help cut down out-of-pocket expenses, but not all plans are created for just anyone. They all have their perks and limitations, so it is important to know what your dental needs are before you buy insurance.
Dental Plans
Dental plans can be broken into two different types: Indemnity plans and managed care plans. Indemnity plans (or "fee for service" plans) are for patients who want to have more options than a selected list of providers when it comes to choosing a dental professional. These plans generally require more paperwork than managed care plans do, because insurance subscribers pay up-front costs and get at least partially reimbursed after submitting claims forms to the insurance provider. Some indemnity plans pay for typical dental care costs and only require subscribers to pay a deductible. There are three primary managed care plans: Dental Preferred Provider Organization (PPO) Insurance Plans, Dental Point of Service (POS) Insurance Plans, and Dental Health Maintenance Organization (DHMO) Insurance Plans. Managed care plans amount to less paperwork and, typically, lower costs than are associated with indemnity plans. However, subscribers will have to select a dental professional from a list of pre-approved providers.
Usual, Customary, and Reasonable (UCR) Fees
"Usual, customary, and reasonable" (UCR) fees are commonly used in the benefits packets given to dental insurance subscribers. These fees are established by dental insurance companies based upon how much typical dental procedures should cost. If an insurance company determines that a certain procedure's UCR fees are $50 and the dental office charged a subscriber $70, the subscriber would be responsible for covering the $20 difference.
Three Procedure Types
Dental insurance companies typically group dental procedures into three different categories: preventative, basic (or restorative,) and major. Preventative care generally consists of routine cleanings, examinations, and sometimes X-rays. Basic (or restorative) care usually includes fillings, tooth extractions, and root canals. Major work, such as bridges, crowns, implants, and surgical extractions are all usually considered major dental work. Dental plans should cover the majority (if not all) of preventative care because it helps curb costs associated with avoidable problems. Basic care should also be largely covered. However, major procedures are less commonly covered by dental insurance companies. Some plans do cover at least part of the major procedures.
Cosmetic Dentistry
Cosmetic dentistry procedures such as porcelain veneer and teeth whitening are not usually covered by dental insurance plans if their sole purpose is cosmetic. Some cosmetic procedures, however, may be covered if they are considered restorative or helpful to maintaining dental health. For example, coverage of orthodontic braces (or porcelain veneers in lieu of orthodontic braces) as well as cosmetic repair after injury may be offered.
Scheduling Issues
Some dentists' offices schedule appointments based on who has what insurance coverage. Potential subscribers should check with the dental insurance company to make sure that appointment scheduling limitations won't be a problem with a selected dentist.
