Because of rising health-care costs and dental costs, a shaky economy and efforts to save money, more employers are reducing choices and benefits for employees, especially in dental insurance. Patients need to take a proactive stance when it comes to researching the best type of dental insurance plan to protect them and their family. Dr. Tsai never lets insurance benefits interfere with proper and proactive dental health – your health. Though it's your dental insurance, Dr. Tsai has team members dedicated to helping you understand the details of each dental insurance plan. If you ever have questions about your dental coverage, please give her team a call.
Despite rising healthcare costs and standard of living, most insurance companies have not increased basic benefits in over two decades. This explains why most patients continue to pay what are known as copays. Dental insurance plans also include a deductible, which is defined as a pre-agreed-upon amount of money that a patient must pay before insurance companies pay for treatments and services. Deductibles are also commonly known as out-of-pocket expenses. Patients must consider deductibles and copays, out-of-pocket expenses, as well as money paid for treatments or procedures that aren't covered under the dental insurance policy to dental providers.
Other terms commonly found in dental insurance policies include capitation, reimbursement, and Flex Spending. Many dental providers, especially those who belong to HMO organizations, offer capitation plans. Such plans pay a dentist a set amount each month whether or not you come into their office. They also pay a predetermined amount of money for specific dental procedures: no more and no less, regardless of how much time, effort, visits or procedures a specific patient may require. These plans tend to yield lower-quality dentistry as the doctor's incentive is to not see you or to perform the minimum preventative treatment possible. As a result, high-quality dentists like Dr. Tsai and her team choose not to work with HMO plans.
A dental Flex Spending Account is a medical or health expense account set up through an individual's bank, broker or employer. This health-related expense account may be used to meet unexpected or planned-for dental expenses. In most cases, a set amount from your paycheck is deposited into your flex account during each pay period. Similar to health savings accounts, some money placed in flex spending accounts are not subject to Social Security or income taxes. Most plans limit the amount of money that may be deposited into such accounts on an annual basis to $2,000-$3,000. However, individuals should know that unused money left in a flex spending account at the end of the year is forfeited, so it's essential to use that money!
Currently, there are two types of plans commonly used::
» PPO - stands for Preferred Provider Organization. This type of organization is made up of health insurance providers who have formed a network of dental professionals to offer services to consumers. Dentists who belong to a PPO offer lower fees to patients. However, individuals belonging to a PPO must choose a dental provider from within the network of dentists offered by the health insurance company in order to save on costs. Patients can choose dentists outside of the provider's network, but this may change their copays. Fortunately, Dr. Tsai is one of the very few highly trained dentists who have remains in network for many of the more common insurance plans.
» HMO - stands for Health Maintenance Organization. Patients enrolled in HMO plans are required to choose a dental professional from within the network. Patients who use dentists outside of the network are required to pay that dentist's bill in full. Patients should know that PPO providers are paid on a per-service basis, while dentists belonging to HMOs are only paid a set fee for services, often resulting in lower quality dentistry and lab work. PPO providers are therefore able to provide much higher quality dental care and treatments. Dr. Tsai works with all major PPO plans including unions, individual plans and groups, and employer plans.
Dr. Tsai and her team are available to help patients wade through all the details of their plans, from copays to deductibles and limitations. Her team has worked with almost every dental insurance plan in the Bay Area and can help you navigate the details while maintaining that beautiful smile of yours. Dr. Tsai is a progressive and proactive doctor who focuses on the latest methods, techniques, and tools dentistry has to offer. She is dedicated to preserving your natural tooth structure, taking care of all your dental needs in a comfortable, conservative, and informative environment.
Have questions about your dental insurance plans? We can help. email or call us: (650)-583-5880
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