When insurance companies explain dental insurance benefits, they often use terms that are difficult for people to understand. People get confused and often make mistakes in choosing coverage. Knowing what these terms mean will help you make better decisions when it comes to choosing the right policy.
Preauthorization
Preauthorization is another word for predetermination of costs. This type of coverage requires your dentist to first submit a treatment plan to your provider. Your provider will examine the proposal and then determine what benefits will be covered.
This decision is based on your eligibility, services that are covered, and any limitations inherent your dental insurance benefits plan. The intention of preauthorization is to prioritize and plan dental services and to allocate funding in advance to best match your coverage to cost.
Coordination of Dental Insurance Benefits
If you are covered by your policy and the policy of your spouse (also known as dual coverage), coordinating benefits will maximize the coverage you will receive from both dental insurance plans.
Non-duplication of benefits
Some companies do not allow their insured to coordinate benefits. They write a clause into the policy that prohibits overlap if the insured is covered by two separate policies.
Annual Dental Insurance Benefits limitations
Insurance companies want to help people, but they also have to make a profit for themselves. They are unable to spend an unlimited amount of money. Therefore, they have to place annual limits on the dollar amounts, treatments, and procedures you can receive.
Least expensive alternative treatment (LEAT)
Dental insurance benefits will often cover the least expensive treatment options. The insured may always choose a more expensive treatment-such as cosmetic dentistry services-- if he or she are willing to absorb the difference in cost.
Premium adjustments and Re-evaluations
It is necessary that both you and your employer lobby your insurance company to regularly re-evaluate premium levels. This needs to be done in order to ensure that the UCR or Table of Allowances that the company bases its payouts on are in line with actual fees charged by dentists in your area.
Peer Review for Dispute Resolution
This system evolved out of the need to resolve disputes between patients, third parties, and dentists. If a case goes to peer review, individual patient records, treatments and results are thoroughly examined in order to determine a fair resolution. The intent is to resolve the dispute for the benefit of all parties.
How do third parties categorize dental services?
That is a good question. There are basically four service categories that your dental insurance benefits plan falls under.
Diagnostic
Diagnostic services are exams, x-rays, and other procedures that are used to evaluate your oral health and detect infection, malfunction, or disease.
Preventive
These are treatments that counteract decay and disease, such as dental cleanings, fluoride treatments and the application of sealants.
Restorative
When teeth get damaged or begin to decay, they must be repaired with fillings, crowns, inlays and onlays used to restore strength and functionality.
Discretionary (or elective/cosmetic)
These treatments are meant to deal primarily with aesthetic issues and are normally considered by the provider as optional services.
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