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Paying for Visits

Armen Hareyan's picture

Dental Insurance

For many people, trips to the dentist are partially paid with dental insurance. In fact, the National Association of Dental Plans estimates that today about 150 million Americans have some form of dental care coverage.

Whether an employer offers dental coverage or it is purchased by the patient there are many options. The January issue of AGD Impact, the newsmagazine of the Academy of General Dentistry (AGD), takes a closer look at dental insurance types and examines whether insurance is even necessary for dental care.

While patients may find dental insurance to be helpful when paying for treatment, sometimes insurance can be a double-edged sword. On one hand, it encourages patients to seek out treatment and it helps pay for some of the costs. On the other hand, insurance can limit who a patient can visit and often does not pay for everything that needs to be done. In fact, in recent years, many dentists have decided to not accept any insurance in their practice. These dentists are called "non-participating" or "insurance-free."

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Cindy Flanagan, DDS, FAGD, AGD spokesperson, does not accept insurance in her practice. "It was hard to bring up the issue of asking patients to pay for treatment themselves, for fear of what they would say," says Dr. Flanagan.

These insurance-free dentists sometimes offer payment plans for more expensive procedures to allow patients to pay a small amount each month until the treatment is completely covered.

For those who still need some extra help paying for dental care, Myron Bromberg, DDS, AGD spokesperson offers this advice, "If you can't get dental insurance at work and the private plans don't make financial sense for you, I would strongly suggest taking $75 a month and putting it into a personal private account to be used only for dentistry. If you are not in need of major dental treatment, you will have money left over after a few years."

Two systems of dental plan coverage

  • Fee-for service or indemnity: This system pays the dentist for each service mostly according to fees set by the dentist. A form of this is direct reimbursement, in which a business or other group decides how much to cover for each person.

  • Managed care: This is a system that controls the fees set for covered services. Managed care can be divided into two categories: 1) capitation or dental health management organizations (DHMO) and 2) preferred provider organization (PPO) plans. These plans are closed which means patients must select their dentist from lists of providers.