Restorative care – gold restorations and individual crowns
Oral Surgery – removal of impacted teeth and complex oral surgery procedures
Periodontics – treatment of complicated periodontal disease requiring surgery involving bones, underlying tissues or bone grafts
Orthodontics – treatment including retainers, braces and/or diagnostic materials
Dental Implants – either surgical placement or restoration
Prosthodontics – fixed bridges, partial dentures and removable or fixed dentures
Will the plan allow referrals to specialists?
Will my dentist and I be able to choose the specialist? Some plans limit referrals to specialists. Your dentist may be required to refer you to a limited selection of specialists who have contracted with the plan’s third party. You also may be required to get permission from the plan administrator before being referred to a specialist. Is you choose a plan with these limitations, make sure qualified specialists are available in your area. Look for a plan with a broad selection of different types of specialists. If you have children, you may prefer a plan that allows a pediatric dentist to be your child’s primary care dentist. Since specialized treatment is generally more costly than routine care, some plans discourage the use of specialists. While many general practitioners are qualified to perform some specialized services, complex procedures often require the skills of a dentist with special training. Discuss the options with your dentist before deciding who is best qualified to deliver treatment.
Can you see the dentist when you need to, and schedule appointment times convenient for you?
Dentists participating in closed panel or capitation plans may have select hours to see plan patients. They may schedule appointments for these patients on given days, or at specified hours of the day, restricting your access. Some dentist’s fees for seeing you on weekends or during emergencies are high than those the plan allows. You may be required to pay additional costs yourself. If you select these types of plans, have a clear understanding of your dentist’s policies as well as the plan’s dentist-to-patient ratio. It’s the best way to insure your access to care is not unduly restricted and that you are not surprised by higher fees the plan does not cover.
Will the plan provide benefits to patients who may also be covered by another dental plan?
It is not unusual to be eligible for dual benefits. You may be covered under you company’s plan as well as under that of your spouse’s employer. In analyzing your options, make sure to look for a plan that allows coordination of benefits.
Getting the most from your plan
To take full advantage of your dental benefits plan, visit the dentist regularly and get the preventative care that will keep your mouth healthy. Follow the treatment plan you and your dentist have developed. Do your dental homework – brush and floss regularly and maintain a regular schedule of oral examinations and teeth cleanings.