The Elements of a Dental Insurance Contract

Insurance policies are filled with various terms that are barely understandable to people who may or may not have the rudimentaries of insurance down pat. It's even a bit complicated when you're talking about dental insurance because it concerns a part of your body. However, given that dental procedures in the US are already costly to begin with, taking out an insurance policy is a cushion that works.

The main part of a dental insurance plan is the maximum, which is the highest amount that the provider will cover for your procedures during the entire calendar year. The patient is responsible for paying for expenses above the maximum. A dollar deductible is the amount that the plan will shoulder for your treatment after you pay a portion of the dental bill.

Some dental insurance policies have coinsurance provisions, which help a benefit plan determine a percentage of how much it will cover for the treatment even when a deductible is reached. You will still have to pay the balance, however. The coverage levels vary from plan to plan; for example: diagnostic procedures are heavily covered under the maximum stated in Class I coverage, while Class III coverage is focused on major treatments and at only 50% of the maximum.

In the end, you should know that it is important to take out dental insurance. Knowing their various elements will allow you to plan ahead and maybe save some money while you see to your dental health.

PPO Dental Insurance at a Glance

Most health insurance plans in the U.S. are either managed by a healthcare maintenance organization (HMO) or a preferred provider organization (PPO). Many healthcare practitioners prefer PPO over HMO due to its suitability in terms of coverage. As you know, dental insurance works differently from other types of insurance since most, if not all, of the dental problems can be prevented and treated with less cost. In exchange for PPO insurance, however, the dentist now becomes a “preferred provider.”

Consumers still have the choice of whether or not to go to a preferred provider, but the cost will be higher in a non-preferred provider. PPOs are also simple; unlike HMOs, PPOs don't need any referrals, let alone a primary care provider, for the plan to take effect. This translates to more patients for a dentist as he can treat patients regardless of referrals. With HMOs, however, patients need proof of referral before the dentist can treat them.

In PPOs, preventive dental care coverage ranges between 80 and 100 percent, basic care at around 80 percent, and major dental work (e.g. implants, crowns) at 50 percent. For a regular check-up worth $50, the patient may only need to pay no more than $10. The rest of the cost is shouldered by the PPO. It's safe to say that patients who regularly practice proper oral hygiene get to pay less for dental care.

Renegotiating Dental Insurance Fees

Getting the perfect insurance fee schedule is certainly the ideal scenario, but it’s also rarely the case. However, what many dentists like you don't realize is that it's never too late for your office to re-evaluate its insurance contracts and renegotiate its fee schedule. Renegotiation can be beneficial—not to mention profitable—to your practice, and it's not as difficult as you might think.

Start by asking some important questions about the insurance companies your office is contracted with, such as: “When did you last negotiate the fee schedule?” It is recommended that you renegotiate for a new fee schedule annually. This will give your office a chance to receive a more substantial reimbursement for common procedures. That said, keep in mind that you can renegotiate anytime you feel your current reimbursement is inadequate.

When you renegotiate, two things will ensure a more favorable fee schedule. One is if there's not a lot of competition in your area, and the other is if you have a good relationship with the insurance company you're contracted with. In both cases, these companies will be willing to participate in the fee negotiation process.

In the end, a firm understanding of how insurance companies work and knowing what you want out of them will give you a solid foundation for renegotiation. It may seem complicated at first, but it is something that your office should do and can benefit from.

Why Some Dentists Hesitate to Raise Their Fees

Like most other services, the cost of dental procedures rise periodically. However, quite a number of dentists are reluctant to raise their service fees perhaps for fear of losing their loyal clients. Although most dental offices review their pricing strategy on an annual basis, not too many of them increase their rates as often as they conduct reviews.

Some dentists do not see the point of raising their fees because it is the dental insurance companies that dictate the reimbursement rates. Still a lot of others wait for the economy to stabilize before deciding on the final figures for rate hikes that are long overdue. Not a few dental offices also choose to minimize the discounts they offer clients rather than charge higher rates.

Regardless of the actual pricing strategy each dental practice decides to adopt, it is crucial to ensure optimum PPO reimbursement rates and thereby remain profitable. Dentists who cater to individuals, families, and corporate clients covered by insurance should thus find ways to seek the highest compensation possible. Among other things, this may require the services of capable third-party providers who can negotiate with insurance companies and obtain maximum reimbursement rates on behalf of the dental office.

Preferred Provider Organizations (PPOs)

If you're an employee working for a company of good standing, you've probably heard of the term “PPO” that's usually discussed along with the many health benefits provided by your employer. PPO stands for Preferred Provider Organization, which is actually a health plan contracting a network of medical service providers available in case you need some tuning up. Referrals and primary care physicians are no longer required to approach PPOs.

Depending on your customized health plan, you might have to shoulder annual deductibles and co-payments upon visiting a member of your company's PPO. However, opting to stick to your family doctor or a medical specialist not in the preferred network will mean more deductions to your health privileges. Going out-of-network means you'll have to pay the doctor directly and file a claim with the PPO for reimbursements.

Health insurances also come in the form of HMOs. You shouldn't confuse PPO with HMO, or Health Maintenance Organization. Unlike PPOs, HMOs do not give reimbursements to employees who consult with doctors outside of the network. HMOs also require a referral from your primary care physician to see a specialist and have your medical expenses covered. Filing a claim with the HMO beforehand is also necessary to receive payment from your company.

PPO is just one of the many words you'll encounter concerning health benefits. Don't just sign agreements without reviewing their terms.

Dental Coverage by Class of Service

The amount of dental reimbursement a dentist receives usually depends on the type of service he or she has performed on the patient. This is known in dental plan terminology as “class of service,” which ranges from Class I to IV. The more extensive the dental treatment was, the less the coverage will be for the dentist. Class I pertains to diagnostic and preventive care. Regular checkups, cleanings, and dental x-rays are usually fully reimbursed.

Class II includes basic restoration; dental plans usually cover 80 percent of the cost of root canal and periodontal work. Class III involves advanced restoration procedures such as installing crowns and dental implants, and plans usually shoulder half of the cost. Finally, Class IV, which isn't a regular in dental plans, covers braces. The cost of orthodontic care is separate from a dentist's annual limit, but patients under 19 years of age may only be eligible for this type of reimbursement.

Keep in mind that most dental plans won't cover you for the whole year, as they usually set a number on the frequency of exams. They can only cover so many preventive care exams before dentists have to wait for next year for reimbursement. Dental plans also include time limits on certain services such as the replacement of prosthetics and orthodontics.

On the Importance of Making Use of Dental Insurance

For some people, oral health is purely about maintaining aesthetics and keeping a presentable appearance. However, as many healthcare professionals will attest, dental health is mainly about sustaining healthy teeth and gums to achieve optimum function of the mouth. For some medical practitioners, one's oral health is a window to one's overall health.

Unfortunately, with the recent tough times in the United States, a lot of people don't have access to quality dental care because of the lack of dental insurance. According to figures posted in the Statistics Brain website, 50 percent of Americans don't have dental insurance. Dental insurance is similar to health insurance except that it covers part of the costs for common dental procedures such as tooth extraction or drainage of gum abscess.

While it is still possible to get dental treatments without insurance, it is challenging since you must have the necessary finances to cover the costs on your own. There may even come a time when you you can't seek dental treatment even when you have a dental emergency (like throbbing pain in one of your molars) because you are strapped for cash, so you wait until money comes in. By that time, it may be already too late to save the affected tooth. With dental insurance, even if you don't readily have cash on hand, you can still seek dental services as needed.

On Full Taking Advantage of PPO Dental Plans

For a dentist trying to establish a solid practice in a community, being part of a PPO or a Preferred Provider Organization can be a good way of making it. A PPO is a medical care plan where members must provide substantial discounts to those who use their services. This can be a profitable arrangement for both members and the PPO alike in terms of number of clients.

Although the health provider member will have to bill patients lower than the standard rate or based on the agreed schedule of fees, it can be offset by the number of clients. People who are covered by this health program will only choose the services of those listed under the PPO. Otherwise, they would have to spend higher for the services of those outside the network.

On the other hand, the PPO dental plan fee can be reviewed based on the records of treatment to confirm if they are suited for the condition and not just to increase the amount of reimbursement. It also includes a pre-certification arrangement where hospital admissions and other non-emergency treatments must have prior approval of the provider. A PPO may cost relatively higher than ordinary insurance, but provides more options for patients in need of medical care.

Like any other plan, a PPO can have both advantages and disadvantages, but its benefits far outweigh whatever perceived flaws the system may have. In fact, it has become a popular alternative to those seeking effective dental health insurance coverage.

On How to Go About Renegotiating Dental Insurance Fees

Dental procedures, whether you're having a tooth pulled out or you're having your teeth aligned, are never cheap. Patients must pay for the expertise of the dentist they visited for the operation, as well as pay for the equipment and materials used for the operation. While having clean and healthy teeth is the right of every person, dentists are running their practice as a job and need to be paid for their services.

To help pay off dental bills, most patients turn to dental insurance plans that could cover (or at the very least, shoulder) the costs. While a pretty useful mechanic for patients, dentists could run into trouble getting reimbursed. Insurance companies who only agree to pay a portion of the bill may sometimes cover even less than they should, leaving dentists with a paltry sum and patients with a bill that's simply too high.

Typically, dentists have the option to negotiate with the insurance company on increasing the fees granted. There will be times, however, when a dentist feels that he should have been paid much higher by the companies. Fortunately, there's an option for the good doctors to pursue a renegotiation with the insurance professionals. This is made possible with the help of a legal firm that can uphold the interests of dentists.

Dentists Need Money Too: Why Dental Fees Increase

If there is one thing about dentistry, or the medical field in general, that makes it financially appealing is the mere fact that people will always need to take care of their teeth. However, the amount a dentist earns depends on the number of patients he or she deals with on a regular basis. Dental plans ensure that dentists always have a set number of people to service every year, but patients nowadays are clamoring for smaller fees and dental insurance companies are starting to reimburse less.

To stay on the game, dentists have no choice but to change their fee schedules. Aside from dealing with the turbulence of dental insurance, dentists are sometimes forced to learn new procedures and/or employ better dental equipment in order to provide their patients with more services. There is also the more mundane aspect of having to deal with “drive-by patients” (those who come only when they need something and never come back) which further strains the dentist's resources.

However, shoddy financial management can also be blamed for when dental fees increase. A dentist may be using outdated fee schedules since he or she didn't regularly consult with the dental insurance company he or she is working with. This often results in poorly-informed decisions like increasing all fees wholesale (something that often alienates patients) instead of fees for specific services only. 

Everything You Need to Know About Dental Reimbursement with PPO

Preferred provider organization or PPO is an organization of health care providers or offices that provides managed care under an agreement with an insurance company. Managed care refers to the methods used by health care providers (like dentists) intended to reduce the cost clients have to pay. It does not intend to reduce the quality of the service but only to look for all possible means to provide the service at a low cost.

Most employees who have a direct reimbursement plan prefer dentists participating in a certain PPO for a number of reasons. Considering that they offer dental services at a much lower cost, they are most likely willing to negotiate the amount clients will claim for reimbursement. This will allow clients to pay less out of their pocket, sometimes much of it are already covered by the insurance.

This makes PPO participating dentists very different from regular dentists. Non-PPO-participating dentists would normally provide services at a fixed price. The reimbursement that comes with the client's plan will also be inflexible, taking much of the cost out of your savings. Clients might be obliged to pay more if they have a traditional dental plan because it comes with a deductible.

Most PPO-participating dentists will require clients to present an ID card provided specifically for enjoying PPO plans. They provide dental services even to clients whose plans have deductibles or not direct reimbursement. However, clients are obliged to cover the deductibles first before plan covers eligible dental expenses.

All About Dental Reimbursement and How it Works

A dental treatment can be an expensive service. Its cost may vary depending on the level of difficulty or the expected effect of the method used. Basic treatments like extraction and filling are among the least expensive, next to preventive dental exams. Unfortunately, many still find the prices steep and thus refuse to get professional treatment.

Fortunately, there is such a thing as direct dental reimbursement. This is an innovative solution to helping employees get discounts or reimburse cash when they get certain dental treatments as a form of self-funding benefit. It gives the employees the freedom to choose the dentist they want, especially if these dentists aren't among those authorized to provide services through their company-funded dental benefits.

Direct dental reimbursement is popular for its simplicity. It comes with a set of dental plans allowing clients to choose their dentists, pay their bills, and get their reimbursements. Usually, the payment for the benefits are assigned directly to the client's chosen dental office, making it easier to receive.

Unlike traditional dental plans that are based on the type of treatment received, direct dental reimbursement is based on dollar expenditures. Meaning, the client doesn't have to look for dental offices that provide the treatment he needs least or more expensively to get a favorable reimbursement. Clients can also expect very few limitations on the benefits they will receive.