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Kids and Health Care: Dental Insurance and Care

Most managed care plans and standard health insurance policies do not cover dental care. (Some used to; but, starting in the 1990s, they pared back the coverage -- which was usually subcontracted out to specialist insurance groups, anyway.)

In some cases, standard health plans will pay for reconstructive oral surgery and dental work that's the result of damage from an illness or accident. But they're tight about even this kind of coverage, so be prepared to have several doctors state in writing that the dental work is medically necessary.

Generally, insurance companies consider dental care a "budgetable expense" -- something that ordinary families should be able to pay for out-of-pocket.

As a result, dental insurance is fairly common as a stand-alone form of coverage. In many cases, this insurance is marketed by regional dental associations and operates like a managed care health plan. In exchange for your monthly premium, you're covered for dental care (after you make a copayment) from any member dentist.

Dental coverage usually includes payment for preventive care, such as regular checkups, x-rays and cleanings. It also pays for the things most people hate about dental work: fillings, tooth removal, inlays, bridgework, oral surgery and -- ugh -- root canals. This insurance also will help you in a more limited way -- 50 percent is a common figure -- with expenses for dentures and braces.

Typically, dental insurance will not pay at all for cosmetic work on your kids' teeth.

However, dental insurance plans are not as universally-accepted as quality health insurance plans are. If you already have a dentist you like, there's a good chance that he or she won't be on a given dental insurance plan. In these cases, you'll have to decide to find a dentist on the plan that you like -- or skip the plan and just pay cash to the dentist you like.

As a result of this common dilemma, dentists are more accustomed to offering credit terms to patients than MDs are. So, you can often make payment arrangements with a dentist -- especially if you're bringing your kids in for treatment. Terms will vary with each dentist, but a common arrangement includes a third of the fee paid at the time of treatment, a third in 30 days and the final third in 60 to 90 days.

Larger employers will sometimes include dental insurance as an option, if they offer a menu of health benefits. But -- following the risk management advice that dental care is budgetable -- many choose to self-insure the coverage. If you're covered by a self-insured plan (sometimes call a direct reimbursement plan), you take your kids to the dentist and either pay the bill or make arrangements to pay the bill. Then you take a copy of the paid receipt to your employer's benefits office and they cut a check to you for a percentage (often something in the range of 60 to 80 percent) of the dentist's fee.

In some cases, the dentist will accept payment directly from your employer. This is especially true if your employer is a big player in the local economy.

In all, because dental care tends not to involve catastrophic matters -- or result in catastrophic expenses -- the attitude of the insurance industry, human resources experts and many employers is that it can be paid for out of pocket. The question left is: Whose pocket? Yours or your employer's?

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