Dental Insurance Articles
The Role Of The Dentists Office In Dental Insurance Plans
2010-09-06
No matter the type or coverage level of dental insurance plan a consumer has purchased, one thing remains constant-they must go to a dental office for treatment. For some, avoiding the dentist is just a matter of course. Sure, they have coverage, but no one likes the dentist. For others, the concern is over the type forms that need to be filled out in order to receive an insurance payment, and confusion over just what exactly needs to be done and in what order to ensure that a claim is not rejected. Consumers often mistake the role of the dentist's office as being the arbiter of their claims, and are reluctant to submit insurance requests for that reason. It is important to understand the function of the dental office in the insurance process in order to ensure that the best value a consumer's money is obtained.
The role of a dental office in insurance policies will vary depending on the type of coverage that is purchased. If a PPO or HMO type plan is used, policyholders will be required to select a specific dentist that is a member of the network. In these cases, the dentist's office will have all of the necessary forms for insurance claims and will often submit them on behalf of an insured. Their function in this case is not to determine what will be paid and what will not be covered, but simply to detail the services they have provided in a format requested by the insurance company. The company itself will then determine if a client is entitled to a payout or not. Dental offices will also vary on taking payment. Some will require the full amount of the visit up front, and allow an insured to simply receive a check from their company. Some, especially after a long history with a patient, have the ability to receive their portion of the insurance payment directly, with the consent of the policyholder.
For holders of discount dental plans or pay-as-you-go models, any paperwork will need to be done personally, as the dentist's office will not be a member of that "network". In cases such as these, any money paid for services will have to be recovered by the patient, as they are not true insurance plans and are not set up to payout coverage, simply offer discounts.
It is important to be familiar with how your dental provider does business, and what forms they expect you to fill out at your appointment. Understanding their role in the insurance process can make getting paid out for claims simpler and going to the dentist just a little less painful.