Dental Insurance, Who Knew?
It always surprises me how little information is communicated between employees and employers about their insurance, especially about their dental insurance. Usually once a year you are handed a booklet or sent an email giving you an overview of what plans are available to choose from along with a chart indicating what your costs are. And let’s be honest, for most of us our eyes automatically jump to the least expensive plan. A lot of times there will be a snazzy looking graphic showing the cost of a routine dental visit or simple filling and a column indicating your out of pocket expense. In bold numbers there will be a minimal fee or even better yet $0.00. Sounds awesome?! Well, maybe.
We are all familiar with the saying if it sounds too good to be true, it probably is. This is the point where you need to look for some additional information. There are some key questions I think are important when choosing a plan:
- Where can I receive care?
- Do I get to choose my own dentist or do I have to choose from a list of their dentists?
- What kinds of treatment are covered?
Dental plans are kind of like cars, you can buy your basic transportation, the sports car you’ve always dreamed of or something in the middle. What it boils down to is what are your needs, how much can you afford and are you comfortable seeing any dentist? In future blogs I’ll be expanding on these topics.
Do you have question about dental insurance? Please feel free to post it, email me insurance@drjeart.com, or even call the office (586)939-8800.
Dr. John Artemenko, Sterling Heights MI
Summer Vacation
The nice weather has us thinking of summer vacation. Fun in the sun, so close we can’t concentrate on anything else. There are a lot of things that go into planning our vacations away, especially if we plan to leave the USA. Besides the where, when and how do we get 
there, we have to think about what we leave behind. The mail pick up, pet care, outside home maintained. Come to think of it, is your mouth ready? That probably sounds like a silly question, who thinks about that? Good thing for us the ADA or American Dental Association does. What happens if you’re away from the United States and have a tooth problem, worse what if it’s painful? Being proactive about dental care can be one way to avoid an unexpected situation.
Some people are proactively having dental care preformed in other places outside of the US. This list of questions comes from the ADA site having to do with patients leaving the states and having dental procedures performed. It got me thinking about the time my Mom’s friend went to Ireland with an infected tooth; she had to have a “root canal” procedure to get out of pain. That got me thinking, these questions work for that situation as well. The ADA site has helpful information for all different situations, these questions come from there.
Questions and Considerations Prior to a Dental Vacation
How will you determine the qualifications and experience of the dentist who will be treating you in a foreign country?
How is payment processed?
If you have dental insurance, will the benefits cover treatment that is performed outside the United States and if so, to what extent?
What happens if something goes wrong during or after treatment? Would you need to return to the country where you received treatment? Can you afford that?
If you need corrective care after you return, will that be covered by your dental insurance or will you have to pay out of pocket for another dentist to provide corrective care?
If something goes wrong after receiving dental care in another country, what are your legal rights?
These questions made me think, hope it helps.
Do you have Open Enrollment, Insurance Changes or Pending Treatment?
Stephanie - Business Coordinator
After a short humid summer, it looks like fall may be coming early. I know most people are enjoying the cooler temperatures and are looking forward to the fall colors. For you parents out there it’s “The most wonderful time of the year” because the kids are back in school and routines are getting back to normal.
Of course this also means for those of us that are fortunate enough to get benefits from our employers that it’s time to renew or change your benefits for next year. It’s also a good point to evaluate what you have used of your benefits this year and see what treatment you forgot about or haven’t scheduled yet.
There are a bunch of reasons it’s an ideal time to take stock of your oral health.
- If you have procedures you haven’t completed yet this year and unused dental benefits, it’s a good idea use up as much as you can before your new benefit year starts. Typically most plans have a contract year that runs from January 1st to December 31st. Besides, why give money back to the insurance company; you and your employer spend a lot of money for that coverage.
- Sometimes we see coverage levels change from one year to the next. Unfortunately it’s almost always a lesser amount covered. I remember a situation from a couple of years ago when a gentleman decided to wait to have some treatment completed into the new contract year, assuming his benefits would be the same. Regrettably his level of coverage changed and his out-of pocket expense went from around $125 to almost $500.
- You have money left in your Healthcare Spending Account. Since most dental procedures (except preventative) have a co-pay and deductible that apply, the money you have set aside can be used at the dental office.
- You went to the dentist earlier this year and he/she told you that you have several areas in your mouth that need attention. The investment of time and money was just too much to deal with and you may have thought it can wait till later. A lot of times the notion of taking care of one or two things is easier to digest than four or five things. Ask your dentist to prioritize a couple of areas needing attention. The advantage is that it’s not quite so overwhelming to you and your pocketbook, you’re utilizing coverage you may not have next year and you’re doing something to make yourself healthier! All great reasons to SMILE.
If we can help you with any of this, come in and visit our office in Sterling Heights! You can also call us (586)939-8800 or email us generalinfo@drjeart.com
Dental Insurance, Who Knew? Part 2
One of the questions in my first post about dental insurance that I think is critical when you are choosing a dental plan is:
Where can I receive treatment?
Some dental plans are called traditional or indemnity plans. This means you can see any dentist you like in any location. You may have less out-of-pocket expense if you see a dentist in their network or a “preferred provider”, but it is not a requirement of the policy in order for you to receive benefits.
A PPO plan is another type. This is where it gets a little tricky. Some PPO plans still allow you to choose any dentist you like, but will pay benefits at a lesser rate or based on a fee schedule. Other PPO plans require that you see a dentist that is part of their network. In most cases you can check with your dental office or even better check the insurance company’s website for the most current listing of network providers or participating dentists.
BEWARE: accepting insurance is different than being a participating provider with a particular company. The difference can cost you $$$$.
Usually one of the most cost effective type plans for both employees and employers is called a capitation dental plan. A lot of times this is a very attractive policy because you may have little to no out-of-pocket-expenses. But you can only see a participating dentist or dental facility. Often times, you are required to pick a dentist or office when you sign up without knowing anything about them. For some people, this is okay. Other people, like me, are dentally challenged or just plain scared. So, I need to know who is sticking their fingers in my mouth.
Lastly, there are some dental discount programs. Typically these are not offered by employers. Usually these are aimed at individuals and again require you to see a participating provider. The participating provider agrees to provide care to you based on the company’s fee schedule. In other words, if the dentist charges $140 for an extraction and the fee schedule allows $100, you pay $100 and receive a discount of $40.
Dr. John Artemenko, Sterling Heights MI
Do you have a question about dental insurance? Please call me (586)939-8800 or email insurance@drjeart.com.
