Dental Insurance Plans
Thursday November 1,
Dear Dr. Mady: I recently started a new business with ten employees and ten more left to hire. My wife and kids are in need of dental treatment immediately. I have been looking into dental insurance plans that I can purchase for them and my employees but have become very confused with the options. What should I look for in a plan that will help my family and employees the most and not empty my business bank account?—Dean in South Windsor
Dear Dean: Being a dental health provider for many years, I do understand that choosing a dental insurance plan can be a difficult task. There are so many to choose from and they all differ in so many ways. Some pay full price of current dental fee guides, others pay a percentage of previous year fee guides, but they all have one thing in common, they deal with dollars. You want to get the best benefits for your family and employees and save the most money, but the insurance companies want to save money also, which turns into their profit. They run a business just as you do.
You will have to carefully research, if you haven’t already, for the plan that will suit your needs the most. The best plan for one employer or family is not necessarily the best for another, so don’t listen to what your friends have to say. The agony of going through all the differences between different plan choices can even be difficult for people who are experienced with the benefits process. On the other hand, quality dental insurance can help you attract and retain good employees. It is a known fact that a dental insurance package is an extremely desirable employee benefit.
It is reasonable to say that offering dental insurance to your employees can be very cost effective and at the same time help them and your own family to prevent and treat dental disease. However, most plans today only pay a portion of dental expenses, and not always the whole amount for a particular service and always up to a certain total maximum benefit per year. This year may be the calendar year or may start from the first date that the insurance is used.
Some plans discourage or exclude certain procedures completely. Other procedures that are covered can be turned down through a pre-determined estimate or claim. Study each plan option with diligence to learn its limitations and exactly what is covered and what is not. Also check to see if there are individual or family deductibles that will be required by you or your employees, or a percentage co-pay and teach them that these are absolutely required to be paid by them at each certain dental visits. If a co-pay or deductible is not paid by the insured, it may be considered as fraud.
The most important thing to remember is not to be insurance driven when choosing a plan or when seeking treatment. Just because a certain plan does not cover a procedure, does not mean that it is not an appropriate treatment option. Allow your dental practitioner to treat your actual dental needs with the best option, and not treat your plan. What I mean is that plans are limited, so don’t limit your dental care to only what the dental insurance covers and try and educate your employees about this, so they understand that what you are providing is not going to fit like a glove on each and every one of them.
Some dental plans do not cover conditions that existed before the employee or family member became eligible under the dental plan. For example, if you had missing teeth before your new insurance, they may not assist you with replacing those teeth. Many do not cover dental implants yet either and full coverage for needed dental specialist referrals. Even if you or your employee and their dentist decide on a treatment modality, your insurance carrier may only cover what is known the least expensive alternative treatment. An example is that if you wanted a fixed bridge that does not come out to replace a couple of missing teeth and your insurance company only covering all or a portion of a removable partial denture because it is a cheaper option.
Most dentists use a current fee guide that is customary for the region in which they practice. Some insurance companies may feel that a customary fee for a procedure is less than what is stated in that current year fee guide. They may reduce the fee eligible for certain treatments, or simply pay the fees from one or more years previous to the current year.
I could write a book on this, but just remember a few things before selecting the dental plan for you company. What exactly is covered, and to what degree and which fee guide. Find out the yearly maximum benefit that will be paid. See if major dental treatment like crowns, bridges and other replacements is covered. See if fluoride treatments and dental sealants that prevent decay are covered. These could save lots of money in the long run. Are there benefits for out of country emergencies when traveling? Does the plan only cover least expensive alternative treatments? Are specialist referrals and treatment covered?
Don't be afraid to ask your dentist or one of the staff there to assist you in your decision. They would be able to tell you the best insurance option due to the fact that they assist their patients with it every day at the dental office. Dental and oral health is an important factor in promoting good general health. Even though benefit coverage is usually taken into account when deciding on forms of treatment, it should NOT be the deciding factor in determining the final choice of treatment.
Questions for Dr. Mady can be e-mailed to firstname.lastname@example.org and more information is available at www.askthedentist.ca
This column is reprinted with the permission of the author and The
Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS
member), Dr. David Mady Jr.. The column appears the first Thursday of
each month in the Windsor Star. Readers with questions can write to "Ask
The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A