It is open enrollment time! Here are some helpful tips on choosing a new dental plan.
If you have dental benefits as an option through your employer, you may be able to help choose what plan you use for yourself and your family. Many dental benefit plans include clauses and fine print that you may not be aware of but should keep in mind when enrolling. Here are the biggest ones we see that often cause patients stress and confusion.
Missing tooth clause: If you have a missing tooth when enrolling in a new plan, and have the desire to get a new tooth in that spot, be sure the plan does not have a missing tooth clause.
IF it does, the plan will now allow any expense to go toward adding that missing tooth back and you will be 100% responsible for all fees to get your tooth back.
Composite downgrades or alternate benefit provision: The benefit plan you chose will tell you they cover fillings under a certain %. That is great right? If they have what is called an “alternate benefit provision” the company will pay a % of the cost of getting the cheapest possible filling done – often amalgam – or silver – filling instead of composite or white filling. This is because amalgam is usually the least expensive option for a filling on a tooth. Most modern dental offices do not offer silver fillings and don’t even have the equipment in their office to even offer these to patients. Although the difference in cost is your responsibility as a patient, the difference is usually not a high amount.
Maximums: Every dental policy puts a spending maximum on how much they will pay towards dental treatment each year. The range is usually between $1000-2000. Any dental treatment exceeding this amount is the patient’s responsibility. Unlike medical insurance, your dental maximum is per person on the policy and everyone gets their own max.
In and out of network providers: This gets frustrating and confusing for everyone. Patients and the dentist/staff alike! If you have a PPO dental plan you are able to choose from a list which doctor is in network. However, having a PPO does not mean that the doctor you go to is always considered in network with your specific plan. There are branches of plans within a company that don’t recognize a doctor in network with the overall company plan. On the flip side of this, there are plans that pay regardless of being in or out of network. We see this all of the time!
Are you confused yet? So are we. A good question to ask is if your plan will give you the same amount of coverage regardless of the provider’s participation in the plan. Insurance companies, employers, and doctors often change being in network with plans and the coverage provided to the individuals.
We understand there can be a lot that goes into choosing a plan. At The Toothery, Dr. Jessica Bertoglio and her staff welcome everyone regardless of what benefit plan you have or don’t have. We want to help educate you on the often confusing topic of dental benefits. And if you don’t have the option of a benefit plan through your employer, we offer our own in-office membership plan which is very helpful and easy to understand!
Give us a call today at 847-893-9099, and our team in Hoffman Estates, Illinois, will be happy to help you and your smile today!