Dentist Finder San Diego

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The four most common kinds of plans are:

1. Direct Reimbursement Programs
2. Preferred Provider Organizations
3. Capitation Plans
4. Indemnity Plans

1. Direct Reimbursement Programs

With these programs, your employer reimburses you directly for part or all of your dental treatment expenses. All procedures and treatment methods are usually covered, and you can see any dentist you choose. The plan may limit the amount of dollars an employee can spend on dental care within a given year, but often places no limit on services provided.

2. Preferred Provider Organizations (PPO)

With this organization, also known as a Closed Panel Plan, you must choose from a group of dentists who have agreed to discount their fees so that they can be a part of the organization. If the patient chooses to use a dentist who is not a preferred provider, then the patient will be required to pay a greater portion of the service.

3. Capitation Plans

Also known as a Dental Health Maintenance Organization (DHMO). In this type of plan participating dentists receive a fixed monthly fee based on the number of patients assigned to the office. Because these plans compensate dentists so poorly, dentists usually must see many patients at one time and get to spend little quality time with their patients. In addition to premiums, patient co-payments may be required for each visit.

4. Indemnity Plans

The most common insurance programs are indemnity plans, which are also called UCR (usual, customary, and reasonable) programs. This type of plan pays the dentist of your choosing on a traditional fee-for-service basis. The monthly premium is paid by the patient and/or the employer to an insurance carrier, which directly reimburses the dentist for the services provided. Insurance companies usually pay between 50 percent and 80 percent of the dentist’s fee for covered services; the remaining 20 percent to 50 percent is paid by the patient. These plans often have a pre-determined deductible, a dollar amount which varies from plan to plan, that the patient must pay before the insurance carrier will begin paying for care. Indemnity plans also can limit the amount of services covered within a given year and pay the dentist based on a variety of fee schedules.

Referring to the program and its fees as “usual, customary, and reasonable” is misleading and causes some people a lot of confusion. These UCR fees are set by the insurance company and do not represent local dentists’ fees. In fact, the UCR fee will vary between dental offices in the same local area!

Key Features to Consider When Selecting a Dental Insurance Plan

When comparing dental insurance plans, consider the following in order to determine whether the coverage is right for you:

• Can you choose your own dentist or are you restricted to a panel of dentists selected by the insurance company? If restricted to a panel, is your present dentist on this panel?
• Who controls treatment decisions – you and your dentist or the dental plan? Some plans may require dentists to follow the “least expensive alternative treatment approach.”
• Does the plan fully cover diagnostic, preventive, and emergency services? If so, to what extent?
• What routine treatment is covered by the plan? What share of the total cost will be yours?
• What major dental care is covered by the plan? What percentage of these costs will you have to pay?
• What are the plan’s limitations and exclusions?
• Will the plan allow referrals to dental specialists? Will you and your dentist be able to choose the specialist?

Visit the Dentist Finder San Diego home page to find a dentist in San Diego now!