Dental plans can vary greatly in the amount of latitude they allow you when you choose the dentist who will provide your dental care. As a part of your evaluation of a dental plan you must determine if the method by which the providing dentist is selected meets your needs.
If you already have a dentist, you may feel that it is important to you to continue receiving dental care from them. For those persons who do not currently have a dentist, or are receptive to the idea of changing dentists, this aspect of the dental coverage package may be less of a concern.
Some dental plans will permit any dentist who so chooses to participate as a provider of dental services for the plan. In these cases the dental plan is said to employ an "open panel" of provider dentists. This type of dental plan is nice in the sense that your current dentist, or else the dentist you would like to utilize, can provide your dental treatment.
Some dental plans dictate that the dentist providing your dental treatment must be one approved by the dental insurance company. This type of situation is termed a "closed panel" of dentists.
The concept of a closed panel plan has to do with the fact that the dental insurance company has negotiated a contract with its network of provider dentists. In return for receiving patient referrals from the dental insurance company the participating dentist has agreed to discount their fees. Utilizing a closed panel is one way a dental insurance company can reduce their costs.
Of course these two forms of panels, "open" and "closed," lie at the extremes. Some plans with open panel features might offer conditions where any dentist can provide your dental care but you receive a greater level of benefits if you choose a dentist who has enrolled with the dental insurance company. Some closed panel style plans may have a provider list that includes dentists and dental specialists nationwide. Other closed panel plans might be much more restrictive, possibly even limiting your dental treatment provider options to just one dental office or clinic.
If you do consider a dental plan that has closed panel features, and even if the dentist you would like to utilize is a member of the plan's network of providers, read through the plan details thoroughly. Make sure you know what allowances are provided for situations such as:
There are some obvious questions that should pass through your mind related to "closed" and "open" panel dental plans. Here are two of them:
The real question is why does the dentist need these patient referrals? The most negative answer is that the dentist's practice is not thriving and attracting new patients on its own, and therefore the referrals from the dental insurance company are needed by the dentist. After all more patients, even if charged discounted fees, might be better than no patients at all.
There can also be positive reasons why a dentist would need an influx of patients. Possibly an established dentist has recently expanded their office or added an associate dentist. From a standpoint of economies of scale, possibly the dental office can now service a larger patient load, and do so profitably even if discounting fees.
As another explanation, it could be that the dentist didn't want to become a member of the insurance company's network but did so because many of their current patients became participants in the plan and the dentist wanted to accommodate these patients rather than lose them. This type of event might occur in a town where a large local employer recently adopted a new dental plan for its employees.
So, as you can see there are a number of reasons, both positive and negative, why a dentist would join a dental insurance company's closed panel network of provider dentists. Look at the situation before you objectively and see if you can make a determination, or just ask the dentist.
As another explanation, you may find that your dentist does indeed participate in many dental plans but not the one you are considering. If so ask them why. They may be able to provide you with insight about the plan that you otherwise could never gain.
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