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Dental Insurance versus Dental Benefits

A common assumption is that dental health included in medical insurance. The confusion arises from the phrase “dental benefits” that is found in health insurance policies. The primary difference between the two is that the “benefits” only cover certain risks. Insurance, on the other hand, takes care of all dental needs.


So how does dental insurance work?


What Does it Cover?

Dental insurance in Maryland policies cover all three aspects of dental health. They include preventive care, basic procedures, and oral surgery. Fillings, crowns, root canals and tooth removal are some of the specific services. You can buy coverage for the entire family, yourself or employees at your firm.

Individual policies also cover periodontics such as braces, and prosthodontics that is, bridges and dentures. However, the insurance company might not pay for these within the first year of the policy and at an increased premium


Deductibles

Like most insurance policies, certain dental insurance plans require that the patient pays for a certain amount of the cost before the insurance company pays. It varies from policy to policy and from one organization to another. The amount is called a deductible.

Take, for instance, a policy that has a $200 deductible. If you have to undergo a dental procedure that requires $190, you will cover the cost at your expense. However, if the cost is $500, then you will settle the first $200. Your policy provider will settle the remaining $300 provided it is within the insured amount.


Waiting Period

Most dental insurance plans in Maryland have an average waiting period of 12 months. It is only after the lapse of this period that you can use the policy to settle the cost of your dental issues. Certain policies may, however, offer a waiting period of only 6 months. Major procedures such as x-rays, on the other hand, have a longer duration of up to 2 years.

The timing of the maturity of the dental insurance cover may also vary depending on the type of procedure. Some organizations only pay for two preventive care visits in twelve months or per the calendar year. Other services such as bridges, x-rays, and tooth extraction might be limited to once in two years or even three years. The restriction on when the insurance can foot your dental bills is the main limitation of dental insurance policies in Maryland and all over the world.


Pre-existing Conditions

The main reason why dental insurance has a strict waiting period and specific intervals between successive payments is to minimize losses. The regulations aim at discouraging people with pre-existing conditions from enrolling for the coverage to take care of ongoing procedures.

Consequently, it might be impossible to find a dental insurance policy in Maryland if you already have a dental problem. Some organizations do not accept applicants with a missing tooth. When they do, they charge higher premiums than usual.


Cosmetic Procedures

Procedures such as teeth whitening, gum contouring, teeth shaping and veneers can significantly improve your facial beauty. Unfortunately, these procedures are not considered a medical necessity. As a result, they are never included among the services covered by a dental insurance policy.

Some, however, cover for braces, but you will pay for a special rider. Plans that do not have a rider have lengthy waiting periods.


Dispute Resolution

Insurance disputes can be costly to all the involved parties. Most dental insurance covers come with a peer review mechanism that handles disputes between the dentists, the patient, and third parties. Such a platform helps solve conflicts amicably without the costly courtroom process. It as well helps at ensuring individual case consideration, fairness and thorough investigation of treatment procedures, records, and results.


Annual Benefit Caps

Insurance companies also control the cost of dental insurance by placing caps on yearly benefits. Besides, the number of allowable procedures within a 12-month period, there are also dollar amount caps. The dollar amount limits might not be an issue if all you need is constant preventive care.

It is essential that you understand these limitations before enrolling for any policy. You can then use it to plan with your dentist on a treatment plan that minimizes out-pocket expenses while maximizing compensation.


Pre-determined Costs

The cost of different Maryland dental insurance policies is, to some extent, pre-determined. The costs vary depending on the type of program. There are four different payment programs that determine how much you pay, when and who you pay.

  • Usual, Customary Reasonable Programs UCR: It allows you to visit the dentist of your choice. However, the plan can only cover a specified percentage of what the dentist charges or a certain “customary” fee limit, whichever is less. There is little regulation in this sort of payment plan and the costs rarely reflect the dentist’s charges.
  • Direct Reimbursement: In this case, you get reimbursed a predetermined percentage of your expenses on dental care, irrespective of the category. It also allows you to seek dental help a preferred dentist
  • Capacitation program: A contracted dentist receives a monthly payment per patient or family that has enrolled on the program. The dentist agrees to offer specific treatments in return. The amount paid to the dentist is almost always less than the insured amount.
  • Table/ schedule allowance programs: It determines the dollar amount that the insurance plan will pay for each of the services lists in the table. You will cover any extra charges out of your pocket.

Find out from your insurer the program that it uses and check if it will meet your dental care needs.





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