In the last blog post we talked about the different dental insurance plans that exist. Today I want to talk about the types of procedures that you may want to have covered. I do want to start off by saying that everyone is different. When you are shopping for insurance, it may be a good idea to know what type of procedures you may have had done in the past, because those procedures can inform you on what type of coverage you will need in the future. Another idea to keep in mind is what types of oral health goals you personally want to set for yourself so you can get the best smile going forward.
When looking for insurance coverage there are several categories that insurance companies use to label certain procedures. The three main categories are preventative, basic and major. Preventative or preventative and diagnostic care is considered all the dental care received that helps with prevention of disease and routine diagnostic procedures. Preventative care usually includes oral exams, cleanings and x-rays. Basic or basic restorative care are simple treatments that help with tooth maintenance, such as fillings and anesthetics. These types of treatments can typically be done the same day as diagnosed. Major or major restorative care is considered complex treatments that help with ailments that require multiple phases of therapy to correct. Major treatments usually include crowns, dentures and bridges. With in the categories of basic and major, there are other procedure types that can fall into those categories; those are Perio, Endo and Oral. Perio or periodontal care is the treatment, prevention and diagnosis of gum disease. Endo or Endodontic procedures include procedures that involve the soft tissue of teeth. Oral or Oral Surgery is procedures that involve the incision of oral tissues and abscesses. With these categories in mind, you should be able to ask a prospective insurance company what percentage of each type of procedure is covered.
After asking for percentages for each type of procedure, the next thing you may want to ask is what specific types of procedures are categorized as and perhaps the frequency and limitations that the plan you are looking at offers. For example, if you know you want to have an insurance plan that covers the entire cost of your semi annual check up, you should ask “what percentage is an exam or oral evaluation covered, and with what frequency?” “would my prophylaxis and bitewings share frequency?” “what about my cleanings?”. These specific questions are important because these are the procedures that your dentist will bill your insurance for. Other procedures you may be curious about are extractions, full mouth or panoramic x-rays, sealants, implants and ortho coverage. Briefly, orthodontic care includes  work to realign teeth and jaws using braces, retainers, spacers, headgear and more. So, if you are looking to straighten your teeth, knowing if your plan covers ortho would be important.
Lastly, and arguably one of the most important questions you want to ask the perspective insurance company are the financial details regarding your plan. Each person has different financial means and finding a plan that affordable should be the most important objective. Start by deciding if you need a family plan, single plan or dependent plan. Ask what is the yearly maximum, the deductible, and the family deductible for the plan. Another question you may want to ask is if there is a waiting period for the policy to kick in. The whole purpose of insurance is to prevent catastrophic financial loss and to make care more affordable. So knowing when all your benefits kick in is especially important.
I am proud that at the Texas Dental Group we take the time to call the insurance and get a coverage breakdown for all of our patients. As well as going over treatment plans so our patients get the most affordable care possible. To schedule an appointment with us, please call the location nearest you: Conroe - (936) 760-3050, Galveston - (409) 740-7744, Homestead - (713) 633-1922, and Richmond - (281) 238-4454.

I’m getting old! In a few short months, I will be turning 26 and as every millennial knows, that’s the age that you get kicked off your parent’s insurance. Now, I know what you’re thinking I am grown, and I clearly have a job (since I am writing this) so I should be able to find and afford insurance no problem! The sad thing is, you are probably correct, but I know nothing about insurance plans or the procedures I should probably have covered. So if you are like me, and you want to know more about the types of dental procedures you will probably need coverage for, keep reading.
The first thing I want to cover is the different types of insurance plans. When you are in the market for dental insurance, there are many different types of plans that offer varying amounts of coverage and varying degrees of flexibility in the provider of choice. For this reason I am going to break down the different types of insurance plans that are currently available.

According to the American Dental Association, the dental insurance types are as follows:

• Preferred Provider Organizations (PPO): A PPO plan is regular indemnity insurance combined with a network of dentists under contract to the insurance company to deliver specified services for set fees and according to the provisions of the contract. Contracted dentists must usually accept the maximum allowable fee as dictated by the plan, but non-contracted dentists may have fees either higher or lower than the plan allowance.
• Dental Health Maintenance Organizations (DHMO)/Capitation Plans: Under a DHMO or capitation plan, contracted dentists are “pre-paid” a certain amount each month for each patient that has been designated or assigned to that dentist. Dentists must then provide certain contracted services at no-cost or reduced cost to those patients. The plan usually does not reimburse the dentist or patient for individual services and therefore patients must generally receive treatment at a contracted office in order to receive a benefit.
• Indemnity Plans: An indemnity dental plan is sometimes called “traditional” insurance. In this type of plan, an insurance company pays claims based on the procedures performed, usually as a percentage of the charges.  Generally an indemnity plan allows patients to choose their own dentists, but it may also be paired with a PPO.  Most plans have a maximum allowance for each procedure referred to as “UCR” or “usual, customary and reasonable” fees. 
• Direct Reimbursement (DR®): Benefits in this type of plan are based on dollars spent, rather than on the type of treatment.  Direct Reimbursement is a self-funded plan that allows patients to go to the dentist of their choice.  Depending on the plan, the patient pays the dentist directly (or the benefit may be directly assigned to the dental office) and then submits a paid receipt or proof of treatment.  The administrator then reimburses the employee a percentage of the dental care costs.  With some plans there are no insurance claim forms to complete and no administrative processing to be done by the dental office or an insurance company.
• Point of Service Plans: Point of service options are arrangements in which patients with a managed care dental plan have the option of seeking treatment from an “out-of-network” provider.  The reimbursement to the patient is usually based on a low table of allowances; with significantly reduced benefits than if the patient had selected an “in network” provider.
• Discount or Referral Plans: Discount or referral plans are technically not insurance plans. The company selling the plan contracts with a network of dentists.  Contracted dentists agree to discount their dental fees.  Patients pay all the costs of treatment at the contracted rate determined by the plan and there are no dental claim forms to file.  Originally these plans were sold to individuals; however, more and more employers are purchasing these types of plans as the dental plan for the company’s employees.
• Exclusive Provider Organizations (EPO): Exclusive provider organization plans require that subscribers use only participating dentists if they want to be reimbursed by the plan.  These closed panel groups limit the subscriber’s choice of dentists and also can severely limit access to care.
• Table or Schedule of Allowances Plans: These types of plans are indemnity plans that pay a set dollar amount for each procedure, irrespective of the actual charges.  The patient is responsible for the difference between the carrier’s payment and the charged fee.  The plan may also be paired with a PPO that limits contracted dentists to a maximum allowable charge.

If you are still with me, that means you have read up on the different types of dental insurance plans that exist. Any given person may have none, one or any combination of these plans. If you don’t know what type of plan you currently have be sure to call your insurance and ask to speak to a representative.
At all the Texas Dental Group offices we accept Medicaid and PPO plans or plans from Preferred Provider Organizations. Please call any of our specific locations to find out if you are considered “in-network” have your insurance card ready when you call. Conroe - (936) 760-3050, Galveston - (409) 740-7744, Homestead - (713) 633-1922, and Richmond - (281) 238-4454.
For more information about dental plans please refer to the American Dental Association website: https://success.ada.org/en/dental-benefits/dental-plan-overview.