Miscellaneous
Sports
Mouth
Guards
Insurance
Terminology
Dental
Terminology
FAQs
Index
Q:
WHAT IS THE PURPOSE OF SPORTS MOUTHGUARDS AND WHAT TYPES ARE AVAILABLE?
A: With so many children participating in sports, the chance
of having a dental injury is a real possibility. In sports like football,
where mouthguards are required, the injuries involving teeth are low.
Yet, in sports like basketball or baseball, where mouthguards are not
worn, the dental injury level increases dramatically. The cost of a
mouthguard, even a custom made mouthguard is inexpensive in comparison
to the cost of the dental treatment cost which can frequently approach
thousands of dollars.
There are two types of mouthguards available: Boil & Bite,
which can be found in most sporting good stores and custom made
mouthguards, which are fabricated by the dentist. The advantage
of the Boil & Bite is cost. Its disadvantages are that they do not fit
as accurately as custom made ones, can be uncomfortable, and frequently
interfere with speaking & breathing. There is a dramatic difference
in thickness with the Boil & Bite compared to a custom made mouthguard.
This can give a false sense of security. Whatever type of mouthguard
is chosen, mouthguards should be considered an essential part of an
individual's sport equipment.
Q:
CAN YOU PROVIDE SOME EXPLANATIONS OF INSURANCE TERMINOLOGY?
A:
Insurance jargon can make understanding one's dental benefits difficult.
Misunderstanding your policy can affect getting the most of the benefits,
which you have, available to you.
Listed
below are some types of dental plans and definitions of insurance terminology.
Direct Reimbursement - Enables employers to offer cost-effective
dental benefits while allowing employees the freedom to choose their
own dentist. Patient is reimbursed directly by the employer.
Home Maintenance Organizations (HMO): This the least expensive
but also the least flexible type of health plan. In exchange for a low
co-payment, low premiums, and minimal paperwork, an HMO requires you
only see its' doctors.
There
are two ways this type of program can be arranged:
Capitation Plan - Patient is assigned to a specific dental
office where a contracting dentist receives a fixed fee per patient
regardless of whether treatment is performed. They are the least expensive,
but are also the least flexible type of health plan.
Closed Panel-Offers a limited number of facilities, and
a limited number of dentists from whom care must be obtained.
Indemnity
or Fee for Service - This coverage allows patients to choose their
own dentist and any specialist. Fees are set according to the level
of coverage purchased by the employer. The insurance company does not
get to decide whether the visit was necessary.
Preferred
Provider Organization (PPO) - A dentist who contracts with an insurance
company to provide care at discount fees. One can refer themselves to
specialists without getting approval, as long as it is with an in-network
provider. This program will allow a patient to go to a non-participating
dentist, however the reimbursement for services will be substantially
reduced.
Point
of Service (POS) - This program is similar to the PPO, but they
have a "gatekeeper" or Primary Care Dentist. In order to get a referral
to a specialist, one must go through their primary dentist.
Self
Insurance - The employer assumes the role of an insurance agency.
Policy Definitions Exclusions - Denies benefit coverage for certain
procedures.
Fee
for Service - Allows the patient to choose any dentist. Coverage
with this feature allows the patient to receive full benefits for treatment
provided by any dentist of their choice. Least Expensive
Alternate
Treatment - An insurance company can substitute a less expensive,
but in the insurance company's opinion, professionally adequate service.
Limitations
- Limits the benefits for procedures or the number of times a procedure
can be covered.
Table
of Allowances - Assigns a specific dollar value to each dental procedure.
UCR
- Usual, Customary, Reasonable
Usual - The fee that an individual dentist most frequently
charges for a given dental service.
Customary - A fee determined the insurance company based
on a range of usual fees charged by the dentist in the same geographical
area.
Reasonable - A fee that is justifiable considering special
circumstances of the particular care rendered.
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