The Ramifications of Indemnity Dental Insurance

Dental Health
By: Spirit Dental
April 28, 2015

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In many cases, indemnity dental insurance is called traditional dental insurance because with this manner of dental coverage you can visit any dentist that you want without having to be limited to a network or a grouping of providers who are "pre-approved" in order for you to use them.

There will usually be a deductible that the patient will have to pay up front for this type of dental insurance, but after that the the dental insurance will cover a portion of the dental costs that are deemed to be "reasonable and customary." Reasonable and customary simply means that these are the usual dental costs that apply to the particular area in which an individual lives.

The actual amount that will be covered by the insurance can vary, but in many cases the dental insurance of this type can cover up to 80% and even 100% of the dental costs that fall under the "reasonable and customary" definition.

Some of the factors that define this type of coverage that is involved includes in many cases, coverage of up to 100% of preventative dental work. This would include regular maintenance and cleaning procedures. For additional charges, up to 50% to 80% of the reasonable and customary fees would be covered.

The term "reasonable and customary" defines the types of procedures that are covered and consequently providers inclusion of payment can vary widely from provider to provider.

In many cases a maximum dental benefit limit per year is established. If treatment requires extra costs beyond this limit, then the patient would be expected to pay the balance. It is desirable in this instance to locate coverage which has a maximum limit that would include any charges that occur.

Specific services that are included in indemnity dental insurance are defined by a fee schedule. In other words, each dental procedure will specify a specific fee amount that will be reimbursed to the provider. If the dentist charges a higher rate than that which is provided by the dental insurance, then the patient will be expected to pay the difference.

All in all, this type of dental insurance does a very good job in general of providing coverage for maintenance and cleaning, but the patient should be prepared to have some out of pocket expense for the deductible and for excess charges from the provider, that the insurance policy may not pay at a 100% level.

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