Open and closed panel dental plans: How will the dentist who provides your treatment be chosen?
Dental plans can differ widely in the amount of latitude they allow you when choosing the dentist who will provide your dental care. And as a part of your evaluation of a plan, you must decide if the method allowed meets your needs.
If you already have a dentist, you may feel that it's important for you to continue receiving care from them. If so, you'll want an open panel plan.
For people who do not currently have a dentist, or are receptive to the idea of changing, either an open or close panel feature should be just fine.
"Open panel" dental plans.
Some programs are set up where any dentist can participate as a provider of dental services for the plan's members. If so, it's said to have an "open panel" feature.
This type of option is nice in the sense that your current dentist, or else the dentist you had hoped to go to, can definitely be used to provide your dental treatment.
Traditional (indemnity) dental insurance plans typically feature an open panel arrangement.
"Closed panel" dental plans.
Other programs specify that the dentist providing your dental treatment must be one approved by the plan. This type of situation is termed a "closed panel" of dentists.
The group of dentists you can choose from might be as large as a nation-wide network. Or, at the other extreme, as limited as a single dental office.
Why closed-panel plans exist.
The concept of a closed panel has to do with the fact that the company administering the plan has contracted with provider dentists to form a "network." In return for receiving patient referrals (the members enrolled in the plan), the participating dentists have agreed to discount their fees.
For a dental insurance company, setting up a closed-panel network is one way they can help to control and more accurately project their costs.
Health-maintenance organizations (HMO's) and Preferred-provider organizations (PPO's) are types of closed-panel coverage. So are Discount / Referral dental plans.
Some dental plans offer open and closed-panel features.
Of course having a completely open or closed panel are the two extremes. Some plans are designed so they have at least some allowance for both options.
Open plans that have closed-plan features.
Some open-panel plans have a feature where, yes, any dentist can provide your dental care but you receive a greater level of benefits if you choose a dentist who is a member of their network.
Closed plans that have open-plan characteristics.
Some closed-panel plans are so large or dominate in their geographic area that the fact that you must choose an enrolled dentist is a moot point because most local dentists are members.
Problems with closed-panel dental plans.
If you do consider a plan that has a closed-panel feature, and even if the dentist you would like to go to is a member of its network of providers, read through your policy's details thoroughly. Make sure you know what allowances are provided for situations such as:
- Dental emergencies that occur when you are out of town, possibly in an area where there are no provider dentists.
- Are dental specialists included as service providers for those times when the types of services they offer are needed?
- Are there any restrictions on the amount of access you have to participating dentists and dental treatment? Are appointments easily scheduled or is there a lengthy waiting period?
Playing devil's advocate.
There's an obvious question that should pass through your mind about "closed" panel dental plans.
Why would any dentist want to join a closed-panel network?
Doesn't it seem strange that a dentist would want to join a dental plan's network of dentists if, in turn, it meant that they must discount their fees? After all, why would anyone want to earn less?
There can be several reasons why they might choose to join and we've listed a few of them below. Some of them are quite understandable. Others don't reflect so well on the dental practice involved.
a) It could be that the dentist really didn't want to join and only did because so many of their current patients have become members of the plan (possibly through a large local employer). The dentist simply wants to accommodate these patients rather than lose them.
b) The dentist joined the network because they need the referred patients that the dental plan can provide. Of course, the real question then becomes why does the dentist need these patient referrals?
It could be that the dentist's practice isn't thriving, and therefore needs an influx of "captive" patients. Or, at the other extreme, possibly the practice is doing so well that another dentist has been added. If so, participation in a closed-panel plan could help to provide the immediate load of patients that the new dentist needs.
