Third-Party Provider

Preventative care is the biggest part of dental care. With proper oral hygiene techniques many dental problems can be avoided ahead of time reducing or eliminating the need for complicated and expensive treatment later on. An important part of preventative dental care is visiting your dentist every six months for a check-up and cleaning. Routine visits tend to be affordable under $100 per visit. However for those with dependents this money can add up especially when combined with any extra treatments that might be needed. Dental insurance will cover the cost of these visits as well as the cost of most dental treatments you may need.

The three parties involved in any dental insurance benefits plan are patient the dentist and a third party who pays a portion of the dental cost. The third-party provider ensures the financial foundation for the plan. This third party might also be contracted by the patient's employer.

Because so much of dental care is preventative many dental insurance plans are structured in such a way to encourage patients to visit their dentist regularly as a measure to avoid disease. This means that some dental insurance plans cover dental specialists only partially or not at all. As well most plans put a モcapヤ on the dollar value of the treatment an individual or family can receive in one year.

Third-party providers offer various styles of coverage. Some forms of coverage are Open Panel and allow you to choose your own dentist; other forms are called Closed Panel and will only cover you if you choose a dentist from a list specified by the third-party provider. The most common form is the Direct Reimbursement option. These types of programs directly reimburse the patient for a portion of their dental expenses. Usually this portion is a percentage of the total cost. Typically these programs cover most treatments. Patients can visit whichever dentist they want.

Another form of coverage is known as モUsual Customary and Reasonable.ヤ This option too allows patients to visit whichever dentist they want. These plans pay a portion of the fees for モcustomary and reasonableヤ treatment. However definitions and examples of モcustomary and reasonableヤ vary from plan to plan.

A third type of coverage is a モTable of Allowancesヤ plan. This plan lists the amount it will pay for each procedure and will pay only this amount. Often the cost of the patient's individual treatment is higher than the listed amount so the patient has to pay the difference out of his or her own pocket.

A fourth type of plan Preferred Provider Organizations (PPOs) contract with dentists to lower their fees in exchange for having been selected for the plan. This is an example of a Closed Panel plan.

A final type of plan Capitation pays the dentist a fixed amount per patient or family. The dentist in return provides specific treatments such as cleanings of fillings to the patient or family at no charge. The patient may however have to pay a portion of the cost for specialty treatments. Capitation plans are Open Panel.

There are three types of third party providers. Dental Service Corporations are not-for-profit organizations that negotiate and administer dental care contracts to individuals or groups. Insurance Carriers are for-profit companies underwrite the financial risk of and process payment claims for dental services. Self-Funded Insurers use their own funds to cover the cost of dental care to their employees. These plans usually come with limitations on services and fixed-dollar allocations.

Be sure to discuss all possible treatments for dental conditions with your dentist. Some options he or she suggests may be covered by your plan while others might not be.

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