Copyright © 2011–2018 Delta Dental of Tennessee | All Rights Reserved | 240 Venture Circle, Nashville, TN 37228 | (800) 223-3104 The information provided on this site is for general education purposes only and is not intended as a diagnosis, treatment, or a substitute for professional medical or dental advice, diagnosis, or treatment. Consult your dentist or physician for information or treatment specific to you and your health.
In the United States, Participating Provider Network or PPO, also referred to as Preferred Provider Organization, is an organization governed by medical doctors, hospitals, other health centers, and medical care providers. This organization has an agreement with an insurer or the third party administrator to provide health insurance to the people associated with their client at reduced or low rates. Participating Provider Network plan may work similar to a DHMO while using an In-Network facility. However, a PPO allows Out-of-Network or Non-Participating Providers to be used for service. Any difference of fees will become the financial responsibility of the patient, unless otherwise specified.
UnitedHealthcare has a large number on in-network preferred providers, over 200,000, so you won’t have any trouble finding a dentist in the plan. Cleanings and X-rays are covered 100 percent. Here are the charges you pay for basic services: exam - $25; root canal - 50 percent; fililngs - 30 percent; extractions - 30 percent. The coverage has no age maximum limitations. Deductible limits are $50 - individual, $150 - family of three with a 6-12 month waiting period for certain services. Cleanings and X-rays are covered with zero co-pay or deductible twice yearly.
Dental plans will usually cover a portion of your costs on different types of dental procedures. Some plans focus more on preventative and basic dental care, but offer less coverage on major dental procedures. It's important to understand what's best for your dental health. If you routinely need a root canal or get cavities, you'll want a plan that provides better coverage on those types of procedures. In contrast, if you have relatively healthy teeth then you might not need to pay for the extra coverage.
More than 90 percent of dental insurance policies carry a “missing tooth clause” or a “replacement clause.” Many include at least one of these clauses, but most have both. A missing tooth clause protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect. For example, if you lost a tooth before your coverage started and later decided that you would like to have a partial, bridge or implant, the insurance company would not have to pay for that service if they have a missing tooth clause in the plan. A replacement clause is similar except that the insurance company won’t pay to replace procedures such as dentures, partials or bridges until the specified time limit has passed.
DentalPlans.com isn’t an insurance company, but they work with dental service providers to reduce the cost to see an out-of-network dentists. In this way the company gives access to some of the same dental benefits offered by employers through typical group insurance, but more closely resembles a prescription discount card. For example, the estimate we received for a 6-month checkup was only $15. The annual cost for the plans range from $100 – $175 depending on the location and number of people covered.
This is more affordable than dental insurance and there are over 5,400 dentists currently in the Carrington network. The Carrington plan provides a discount that’s usually over 50% on preventative and routine procedures with smaller discounts on other types of procedures. The price for treatment will vary from state to state and affect the percentage of your discount, but some examples of discounts include 51% off a routine check up, 51% off the extraction of a tooth, 50% off a dental cleaning, and just 20% off adolescent braces.
The benefits of choosing MetLife are that they have a number of different plans available and they are well respected within the dental insurance industry. They have a broad network of dentists who work with them and they have significant coverage with a low deductible. The downside is that you have to visit dentists within their network in order to save.
Savings plans are NOT insurance and the savings will vary by provider, plan and zip code. These plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The discounts are available through participating healthcare providers only. To check that your provider participates, visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. You will receive the discount off the provider’s usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Note – not all plans and offers available in all markets.
Like most kinds of health or ancillary medical insurance, there are deductibles involved in dental insurance. Generally, the deductibles are per individual or per family depending on your plan. Some companies require that you meet the deductible on each member of your family while others have a family amount that you have to hit – no matter who the person receiving the care was. Deductibles can range anywhere from $100 to $500 or more. Obviously, the higher your deductible, the less likely you’ll be to take full advantage of your insurance.
The final kind of dental insurance is indemnity dental coverage. These plans allow you to visit any dentist and they will pay a fee for the procedures you have done. They calculate a set amount that they’ll pay for each type of procedure and any additional amount would have to be paid by you out-of-pocket. They also have an annual maximum which can sometimes be higher than other types of plans. One of the downsides is that you have to pay for all the services upfront and submit paperwork in order to get reimbursed.
I could have paid the average of $360 a year for a dental policy in my twenties. Or I could have paid out of pocket for two dental exams, including cleanings and X-rays, which, in 2011, cost an average of $370 combined. In that case dental insurance wouldn’t have saved me much money. And if I went to a dental school or clinic for treatment, I could have saved even more on out-of-pocket costs.
Preventive care may seem optional if you have healthy teeth and good oral hygiene, but it saves money in the long run. I went without dental insurance for three years in my twenties, and did what most of my peers did in that situation – simply didn’t visit the dentist. Then I enrolled in a graduate program which required students to have medical and dental coverage. At my first dental visit, I had numerous cavities. Getting them all filled required nine or ten appointments in the nine months of my academic year.
Humana individual dental plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Benefit Plan of Louisiana, Inc., or DentiCare, Inc. (DBA CompBenefits). Discount plans are offered by HumanaDental Insurance Company, Humana Insurance Company, or Texas Dental Plans, Inc. For Arizona residents: Insured by Humana Insurance Company. For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company, or DentiCare, Inc. (DBA CompBenefits).
Our health benefit plans, dental plans, vision plans, and life insurance plans have exclusions, limitations, and terms under which the coverage may be continued in force or discontinued. Our dental plans, vision plans, and life insurance plans may also have waiting periods. For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker.