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Nasser Antonious, DDS, MAGD, FICOI
Master of the Academy of General Dentistry
Fellow of the International Congress of Oral Implantologists

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Understand Your Dental Insurance

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Understand Your Dental Insurance
Preferred Provider (PPO) Dental Insurance
The Right Dental Insurance For You
Five Things You Should Know When Choosing A Dental Insurance Plan
Selecting An Affordable Dental Plan For Your Family






Understand Your Dental Insurance

arrow Understanding Your Dental Insurance
arrow Basic Dental Insurance coverage falls into three major categories:
arrow Types of Dental Plans
arrow Behind the times
arrow The choice is yours

Understanding Your Dental Insurance

It is likely that you get your dental coverage at work. If your employer offers dental coverage, try and find out if you have several types of dental plans to choose from. Most dental plans cover a maximum of $1000-$2000 of dental services per year. If your employer does not offer dental coverage, you are advised to purchase an individual Dental Insurance policy.

Understanding Dental Insurance is important for both your health and your budget. You should be perfectly aware of what is covered in your policy and what is excluded, how much you will have to pay, what waiting periods there will be before your coverage starts working, etc. Most dental programs do not cover dental treatment solely for cosmetic improvements.

A dental insurance plan is a contract between you and an insurance company that, in most cases, is coordinated by your employer. If that’s the case, the insurance company and your employer are responsible for negotiating the details of the plan. Because our office has no control over this contract, we cannot request additional coverage for you.

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Basic Dental Insurance coverage falls into three major categories:

Preventive and Diagnostic Dental Care

Nearly all Dental Insurance policies cover basic dental services such as checkups, x-ray pictures, cleanings, and some other procedures preventing tooth and gum disease. Since regular dental care prevents more serious potential problems, such coverage can be rather important.

Basic Dental Care and Dental Procedures

Basic dental procedures include fillings, fixing chipped teeth, tooth extractions, periodontal treatment, root canals, etc. However, with some Dental Insurance providers, some procedures can not be listed as basics, for instance, root canals. It is up to you to select a Dental Insurance provider who covers most items of basic dental care and dental procedures.

Major Dental Care

Major dental care usually includes crowns, bridges, denture work and orthodontics. Most Dental Insurance plans cover 50 percent of major dental care costs.

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Types of Dental Plans

There are several kinds of dental insurance plans. The four most common kinds of plans are:

  • Direct reimbursement programs
  • Preferred provider organizations
  • Capitation plans (also called dental health maintenance organizations)
  • Indemnity or "usual, customary and reasonable" plans

Direct reimbursement programs

In direct reimbursement programs, your employer reimburses you directly for part or all of your dental treatment. All procedures and treatment methods are usually covered, and you can see any dentist you choose.

Preferred provider organizations

In a preferred provider organization (PPO), you may choose from a group of dentists who have agreed to set fees so that they can be a part of the organization. In exchange the insurance company will offer these dentists a preferred provider status. A PPO insurance policy can reduce your dental expenses if you utilize a PPO plan participating dentist

Capitation plans

In a capitation plan (also called a dental health maintenance program), participating dentists are paid a set amount for each patient enrolled in the plan. Dentists are paid this set amount no matter how often you visit them (or don’t visit them) and no matter what kind of treatment you get. This generally means that the more work these dentists do for their patients, the less money they’ll make.

Indemnity plans

The most common insurance programs are indemnity plans, which are also called UCR programs. UCR stands for "usual, customary, and reasonable." In these plans, you may choose any dentist and pay on a traditional fee-for-service basis. The insurance company, who is paid a monthly premium by your employer, then reimburses you for between 50 and 100 percent of the dentist’s fee. You are responsible for the remaining 20 to 50 percent after meeting a pre-determined deductible payment. The amount of the deductible is set in the contract between your employer and the insurance company.

Referring to the program and its fees as "usual, customary, and reasonable" is misleading. Most people assume that insurance companies have gathered statistics and that these statistics are the basis for UCR fees. This is simply not true in many cases. These UCR fees often do not represent local dentists’ fees or the available treatment options. They may be, in fact, simply fees that are set by the insurance company. As a result, different insurance companies often have different UCR fees for the same geographic area and for the same group of dentists!

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Behind the times

The annual limit of dental insurance benefits has hardly budged in forty years. Back in 1960, the average annual coverage maximum was one thousand dollars. Forty years later, it still sits at approximately one thousand dollars, despite inflation and cost of living increases.

The benefits have remained the same, but fees for procedures have tripled or even quadrupled. And most insurance plans often exclude new treatments they can label as "discretionary," including common treatments such as implants, porcelain veneers, orthodontic treatment, bonding, and whitening.

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The choice is yours

If you were to build a house, would you rather have the least expensive contractor who used the cheapest materials and technologies? Or would you rather build a home that will last using quality materials?

You have similar choices when it comes to your dental care. In many cases, your insurance company wants you to consider only the cheapest dental procedures, but we believe that you should be able to choose the best dental treatment and materials for you and your family.

Dental coverage is there to help you reduce your dental expenses, but only your health and expert advice should be determinant in your dental treatment decisions.


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back to Previous Page
Understand Your Dental Insurance
Preferred Provider (PPO) Dental Insurance
The right Dental Insurance For You
Five Things You Should Know When Choosing A Dental Insurance Plan
Selecting An Affordable Dental Plan For Your Family

Sunnyvale Dental Care Accepts Most Dental Insurance Plans
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Nasser Antonious DDS is licensed as a general dentist in California. Sunnyvale Dental Care established since 1995
Sunnyvale dentist, Nasser Antonious DDS welcomes new patients from all areas including Sunnyvale, Mountain View, Santa Clara, Cupertino, Campbell, San Jose, Saratoga, Los Altos, and Los Gatos
General dentist, Preventive dentist, Cosmetic dentist, Invisalign dentist, Implant dentist, Children dentist, Sedation dentist

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