There are many types of medical or dental health insurance plans that patients might seek.  This information will be discussed in multiple sections – click the //”Refresh//” button for more.

FEE FOR SERVICE – Medical or Dental Health Insurance Plan

This is the upper end of medical or dental health insurance plans that may offer coverage to patients who choose their own out of network doctors or dentists.  In this type of coverage doctors or dentists are allowed to charge their prevailing fee but the insurer will only pay up to a fixed amount.  The difference between what the insurer pays and the doctors or dentist’s fee is usually paid out of pocket by the patient.

Most dentists will either accept payment directly from an medical insurance company or will at least fill out the paperwork for patient reimbursement.  This type of plan will allow patients the freedom to see the greatest number of dentists and with the highest amount of dental benefits but this coverage comes at a much higher cost in premiums to the patient and/or employer.  Some patients may not be willing or able to pay the higher premium and the same is true for employers.

Even with this type of premium medical or dental health insurance plan patients may find that their covered benefits and annual maximum still keep their overall reimbursement lower than hoped.  This is because the benefits patients receive, including the nonsensical UCR (usual, customary & reasonable) rate, annual/lifetime maximum and covered/excluded procedures is again directly related to the premium paid.  These other terms are discussed elsewhere in this series.

–Dr. Jeffrey Dorfman, Director
The Center for Special Dentistry

The Center For Special Dentistry is NOT a member of any dental insurance plan network.