“BUT DOC……..YOU’RE NOT ON MY LIST” DENTAL INSURANCE

“BUT DOC……..YOU’RE NOT ON MY LIST”

            Come October many employees go through “Open Enrollment” with the opportunity to stay with or select a new dental insurance from a grouping picked out by their employer.  As a sign of the times, the employer may be giving employees a choice between an HMO or a PPO type plan.

The HMO plan usually has a lower premium and sometimes no deductible.  These plans are marketed very well and may look very attractive on the surface, but restrict the dentist you can see and also may not cover all dental procedures. I know of some insurance products that only have 1 or 2 dentist in the whole county on their list and may not have any specialists at all.

The PPO plans give the patient the ability to go “out of network”.  This means you can choose a dentist on the list or a dentist  NOT on the list.  Most of the time the coverage is the same if you go “in” or “out of network”.   The insurance company will tell you that if you go “out of network” and  if your dentist’s fees are higher then what the insurance company feels is appropriate for the geographic area then you may incur a cost.  In most cases I know my fees are very comparable as well as many of my colleagues.  To be sure you can ask your dentist and they will be able to let you know if you will incur any out of pocket cost for your preventive care. If you will incur any costs I can honestly bet you it will only be a couple of dollars.  In some plans your coverage for non preventive services may drop 10%, which in reality equates to about $20 for a simple filling.  Not that much for the privilege of staying with a dentist that you know and trust and is conveniently located for you.  In rare cases your maximum may be reduce by going to an “out of network” dentist, however that being said, if you are in good dental health that really should not be an issue.  It is not only my opinion that choosing a PPO plan is worth the extra premium expense it is also the opinion of many of my patients.  Most times I have even found that as an “out of network” provider my patients do not incur any extra out of pocket costs. 

Again, I want to stress the MOST important detail in choosing any dental plan is the ability to go “out of network” and see anyone you want to see.  I've never known a patient to be happy with a plan where they are limited in where they could go and the treatment which is considered to be a covered benefit.

My staff is trained in the nuances of many different insurance plans, and since we know what kind of specialist and care our patient’s are likely to need we can help them choose the best plan. I am confident that your dentist’s staff is also well trained and can help you make the best choice as well.  Don’t let premiums dictate which insurance plan you choose.  The benefits the plan offers should be examined very carefully before choosing your dental coverage. 

Also remember that if you have an HSA-Health Savings Account, you can use those funds to supplement your dental care.

Please remember to “SWISH, FLOSS, BRUSH AND SWISH AGAIN” and of course visit your dentist regularly.

Please visit my website, roberthwaldmandds.com, and you will find many helpful videos which will explain many dental treatments.

:) Dr. Rob