A Brief Overview on Dental Insurance

HGLHC participates in the following plans: Aetna , Ameritas, Anthem Blue Cross/Blue Shield, Connection Dental Network, Delta Dental, Guardian, Humana ,Metlife, Principal, United Healthcare, Stop & Shop Healthcare, United Concordia – in their “Preferred Provider” tier.

The “Preferred Provider” tier differs from the “DMO’ (Dental Management Organization) and the “DHM” (Dental Health Management) tier in that clients have a greater range of providers to choose from and the provider services menu is not as limited. HGLHC does not participate in any DMOs or DHMs.

A third type of insurance is a dental “Plan” where no deductible is imposed and no claims are filed but the enrollee receives the service fees as determined by the insurance company as opposed to the dental practice standard fee. This type of plan, while not as cost saving as a traditional insurance plan can have significant savings.

All of these companies maintain a specific fee schedule that as a provider, HGLHC has agreed to. Most of these companies have a service schedule that specifies the percentage of coverage for a specific service category. For example Preventive (hygiene, fluoride, oral health instruction procedures) and Diagnostic (exams, x-rays) services are generally covered at 100% of the fee. Restorative (fillings), Prosthodontic (crowns, bridges, dentures), Endodontic (root canal therapy), Periodontic (gum and bone saving procedures), Orthodontic (teeth straightening), Oral Surgery(extractions, biopsies) have varying percentages, generally 50-80%, with the client paying the remaining percentage of the accepted fee. Most dental insurance companies also require the payment of a deductible (individual and/or family) that must be paid by the client prior to receiving the insurance benefit. This deductible is usually not applied to preventive or diagnostic services. Not all plans cover orthodontia or implant services.

I would be happy to answer any questions about dental insurance- please call me!

Patricia @ (860) 278-4163 ext 23.