Unraveling the Mystery known as Dental Insurance

Dental InsuranceAs your Federal Way Dentist, Dr. Lee and her team have found that many of the hardships patients experience in the dental office stem from confusion with dental benefits.

Today we are going to do our best to level the playing field and make dental benefits a little less scary.  We will do this by addressing some facts(good or not) about dental insurance.  Then in future blogs,  will will address more detailed aspects of the insurance quagmire!

Here we go:

  • Anyone that has ANY type of dental benefits, that are fully or partially employer paid, is extremely fortunate.  When the economy took its downturn, dental benefits were one of the first things to go because the full link between the health of your mouth and the health of your body has not yet been acknowledged by the insurance industry.
  • Dental benefits cannot be viewed as true “insurance” nor can they be compared to medical insurance.  That is like comparing apples and oranges!  No comparison!!  Dental benefits can only be looked at as a “pre-paid” dental account with stipulations attached.
  • Your dental benefits are just that YOUR benefits.  Dr. Lee, your dentist in Federal Way, is blessed to have an office administrator, Cristi, who is extremely knowledgeable about dental benefits and has an extensive clinical background.  However, she also has  well over 1000 patients to look after.  It would be physically and mentally impossible for her to know every detail of every plan.  In this day and age, each patient MUST be an educated consumer and know the details of their own plan.
  • There are different types of dental benefit plans prevalent today.
                               ~~Fee for service
                               ~~Participating Premier Plans
                               ~~PPO(Participating Provider) Plans
                               ~~HMO(Managed Care) Plans
                               ~~Self-Funded HSA Plans
In an effort to cut costs, most employers have gone away from the traditional Fee for Service plans.  These historically have been the best for patients, but because of that, they also had the highest premiums.
Premier and PPO plans are very common.  These encourage you to be seen by an “in-network” provider.  They do however give you the option of being seen out of network.  Dr. Lee does participate in a fair amount of PPO plans.  If there is one she doesn’t, it is because the plan asks things that she feels are not ethical, or they simply reimburse the member dentist so poorly, that there is no way she could remain in business and be partnered with them.
Managed Care plans give you, as the patient, NO choice whatsoever.  You are assigned to a dentist, and that is the only place you can receive coverage.  Dr. Lee will not participate in any of these plans, as they often also dictate the type of treatment administered, or more importantly, not administered!
The Self-funded HSA plans are ones where the employer themselves are the insurance company.  They will issue each employee a “dental debit card” and this is used to pay for yearly dental treatment.
***Fall is the time of the year when most employers offer their Open Enrollment.  This is the time when you can add a family member to a plan.  It is also the time when you can choose your plan.  If given a choice between a PPO and an HMO plan, Dr. Lee will ALWAYS recommend the PPO plan, even if it costs the employee money out of their paycheck.  Remember, the HMO will dictate everything to you, leaving you with no choices.
This is also the time of the year where patients who have FSA’s (Flexible Spending Accounts) will have to designate the amount they want placed in it for 2014.  An FSA is an account that some employers set up that allow you, as the employee, to put money from your paycheck into it, pre-tax.  That money is then used for co-pays during the year.  Cristi is only a phone call away if you would like her to check on upcoming treatment to help you make the decision as to how much to put into your FSA!
***Most important, if you are fortunate to have dental benefits, USE THEM.  The yearly allotment does not roll over.  Each calendar year it is use it or lose it!!!
Next time, we will delve into the different levels of coverage and why some services are not covered and others are.   In the meantime, if you have any questions at all, do not hesitate to call the office for answers!  We are here to help and be your advocate, as much as possible!!  Remember, we are partnered with you in your dental journey!

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