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FAMILY DENTAL - MAY 2012

Q. How can I tell if I have a good dental insurance plan or not?

Dental insurance is actually not insurance, but a benefit plan, although some are not even that. There are different types of plans.
A "discount" plan is widely available (the ones you hear advertised on TV and radio) and marketed to everyone. These plans do not reimburse any cost to you or the dentist. It simply has a few dentists that give deep discounts on certain procedures. There is no cost to the plan whatsoever. Though the discounts are far more than what you would pay for a plan, most people find it frustrating finding a dentist in a discount plans.
With a DMO plan, you can only see one specific dentist for the year. No reimbursement is sent to the dentist for treatment, and you pay the total cost to the dentist. Since the DMO dictated fee is so low (60%–100% less), very few dentists participate, and you compete with sometimes over a thousand patients for availability with that one dentist.
Other plans are true benefit plans that do reimburse a portion of the dental cost. They are subjected to an annual limit. These limits unfortunately have not kept up with inflation over the last 40 years. The average annual limit in 1970 was $1,000. That is still the limit today for most plans. Most of these plans are PPOs, which allow you to see any dentist, not just ones in the plan.
Though dental benefit plans are becoming a smaller and smaller contributor to the overall cost of dental treatment, I feel the true benefit plans are the best. They are less restrictive and give greater availability to the patients. It is hard to determine which of the benefit plans are better. Some plans are finding creative ways to avoid paying for necessary dental work. Lately, I've found a few plans that request a full set of x-rays to be sent to cover a single crown. They want x-rays on teeth that are on the opposite side of the crown, but won't pay for them. Why? Not sure. Many patients had to pay for unnecessary x-rays just to get their plan, which they pay for, to reimburse a portion of the cost.
Though dental benefit plans do give some relief toward dental costs, it is best to sit with your dentist and determine what's best for you. Delaying treatment or only doing what the insurance will allow often leads to more expensive and possibly painful dental work in the future.

ask an expert Dr. Mike Lakota is an LVI graduate and on the health committee for District 203. He was recently chosen as a "Champion" for Evidenced Based Dentistry by the ADA. He is a family dentist with a concentration in cosmetics and TMJ.