Negotiating the Maze of Dental Care Choices: Using a Licensed Insurance Broker

Negotiating the Maze of Dental Care Choices: Using a Licensed Insurance Broker

By Gaye Lucas

Mary wants dental coverage that allows her and her family to continue seeing their favorite dentist.

Dave wants to compare dental care options that will provide the best value for his dollar.

Cheryl needs a dental plan that will cover dental visits and services in other states.

Like Mary, Dave and Cheryl, you’ve probably got your own goal in mind when it comes to dental coverage. You may even have an entire set of goals, especially if you are seeking family coverage.

But if you’re reading this now, it’s likely that you haven’t yet decided on which dental care option is best for you. Consulting with a licensed insurance broker can guide you through the maze of dental care choices and help you find the coverage to meet your goals at a price that falls within your budget.

The many types of dental care options, including insurance and discount plans can be pretty confusing. Add to that the abundance of dental care option providers, and the variety of vendors urging you to sign up over the Internet, mail or phone.

If you don’t have the time or patience to research and understand it all, consider using an expert: a licensed insurance broker.

Licensed insurance brokers invest valuable time meeting stringent criteria required by each particular state’s insurance regulatory agency. They have thorough knowledge of every type of dental coverage including:

  • Direct reimbursement
  • Indemnity/Fee for service
  • Scheduled benefits
  • Preferred provider organization (PPO)
  • Dental health maintenance organization/capitation (DHMO)
  • Point of Service
  • Discount referral card or plan

If you are unfamiliar with some or all of the types of dental products mentioned above, a licensed insurance broker can explain the pros and cons of each and make a recommendation as to which type might best suit your needs.

For each of the product types, there are also numerous product carriers or sponsors. All are regulated by the individual states, except the discount referral product. Some states regulate discount products and others do not, increasing the risk for fraud and misleading advertising. Following each state’s required guidelines for ethics and standards, licensed insurance brokers recommend only products they know will provide benefits as advertised.

Some dental care products are marketed by unlicensed brokers, usually using many of the same advertising vehicles as licensed brokers, such as the local newspaper, the Internet or mailbox stuffers. Unlicensed brokers are not all necessarily dishonest or fraudulent, however, many do not have the expertise or customer service policies in place and there are less avenues of recourse you will be able to take if you are not satisfied with the product you purchase.

So, how do you know if a broker is licensed or unlicensed? Check out the differences below.

 

Licensed vs. Unlicensed Brokers

Not all brokers of dental care products are state-licensed brokers. The following presents information specific to both. Always ask if a broker is licensed in the state where you reside and use extra caution when purchasing dental care products from unlicensed brokers.

 

Licensed
Brokers
Unlicensed
Brokers
Passed state-approved exam certifying broker as a professional
Yes
No
Required to complete continuing education courses to keep current on what’s new in the industry
Yes
No
Have strict privacy policies
Yes
No
Can be censured or disciplined by a state regulatory body
Yes
No
Can provide qualified expert comparisons between dental care products
Yes
No
Can provide quotes on regulated dental insurance and dental managed care plans and all types of plans including discount products
Yes
No
Can provide quotes on regulated dental discount cards
Yes
No
Can sell state-regulated insurance or managed care dental plans and all types of plans including discount products
Yes
No
Reduces risk of fraud and misleading advertising
Yes
No

 

How Licensed Insurance Brokers Work

Most licensed insurance brokers provide fast, user-friendly ways to read about and enroll in plans, such as interactive Internet Web sites and easy-to-fill-out mailers for consumers who are comfortable and want to use these methods.

Licensed insurance brokers are also typically more than willing to meet with you in person or over the phone to ask about your wants and needs and assist you in your decision and the enrollment process. They can readily answer questions such as:

  • Can coverage take effect immediately?
  • Is there a waiting period and why?
  • Is there a deductible?
  • Is 100% coverage possible?
  • Can I continue to see my own dentist?
  • Are implants covered?
  • Is orthodontia covered?
  • Can I pay monthly?
  • Can I have more than one plan?

An independent licensed insurance broker will act as an expert third-party advisor between you (the consumer) and a dental care insurance/managed care plan carrier or discount product sponsor.

Independent brokers may favor one carrier or sponsor with whom they have had previous good experience with, but they can and often do recommend more than one.

How a Licensed Insurance Broker Can Benefit You

A licensed insurance broker can play a key role in helping you negotiate the maze of dental care options. In Mary, Jack and Al’s cases above, a broker can provide individualized service that addresses each of their specific needs and much more.

  • Expert Product Knowledge
    Independent licensed insurance brokers work with dental care options on a daily basis. To remain competitive, they keep themselves informed of new products as they are made available to you. They can provide specific information on one or more available products from a variety of product carriers or sponsors.
  • Product Choice
    Brokers use their third-party advisor status and expert knowledge to provide a range of product choices to you. Independent state-licensed brokers recommend only state-regulated insurance or managed care dental plans. They may also recommend a reputable dental discount card, which may or may not be regulated by the consumer’s state, as some states do not regulate dental discount cards.
  • Product Comparison
    Expert product knowledge and choice uniquely qualify licensed insurance brokers to provide you with detailed descriptions of product types and the different levels of benefits and risk that each offers.You may request to see only products that provide a particular feature or benefit, such as products that allow you to visit the dentist of your choice, or products that offer orthodontia. A broker can pre-screen available products and present only those that offer the particular features and benefits you have requested.
  • Benefit Comparison
    Licensed insurance brokers are familiar with the benefits provided by the different product types and plan carriers or sponsors. They can provide a side-by-side benefit comparison and explain how they differ.
  • Price Comparison
    You may inform your broker of a specific premium maximum you are willing to pay for dental care coverage. A broker can pre-screen available products that fall within your requested range and present the price comparison at the same time the product and benefit comparisons are presented.
  • Time Savings
    An independent state-licensed insurance broker can save you the time you may have spent researching all available dental care options. They’ve shopped and continually monitor the product market to offer you the best choices. Their considerable experience means they can work up product and price comparisons within a very short period of time, allowing you a quick turnaround between time of request and actual receipt of comparison.
  • Less Work
    Licensed insurance brokers provide assistance in filling out online forms and/or any paperwork required by the product sponsor or carrier you choose. Many brokers provide a 24/7 toll-free number to answer any questions you might have regarding the application process.
  • Continued Service
    Once you apply for and become an enrolled member of a brokered dental care product, a client/broker relationship begins. Licensed insurance brokers will advise you of contact information for your particular dental plan.For filed claims or other situations that may arise, licensed brokers are typically available as a source of advice, and can help ensure that you get a satisfactory settlement or resolution in the quickest time possible. If you are not happy with a carrier or sponsor, you may call your broker who may suggest ways to remedy a problem or may suggest another product, if applicable.

Case Study:

Using a State-Licensed Independent
Insurance Broker to Find Dental Coverage

Gina had been searching the Internet for reasonably priced family dental coverage. After checking out several insurance plans, she still wasn’t sure how reliable the carriers were or if the coverage was worth the cost. She was also somewhat discouraged to learn that many had waiting periods and that the crown she had broken the previous week at dinner wouldn’t be covered for at least a year. Gina decided to seek advice through www.dentalinsurance.com.*

Gina didn’t want to just fill out an application on line. She wanted to talk to someone knowledgeable, so she called the toll-free number listed on the site. Gina’s first question was “Are you a licensed insurance broker in my state?” Upon receiving a positive response, Gina felt comfortable proceeding.

The broker spent time asking Gina questions about her immediate and long-term needs, walked her through a comparison of options and prices and gave her some background on different carriers. Gina really wanted to have an insurance product that allowed her family to visit providers of their choice.

For Gina’s immediate situation (her broken crown), the broker suggested she apply for both a discount dental plan with no waiting periods and a more comprehensive PPO dental insurance plan. For a reasonable cost for her entire family for one year, the dental discount plan required only two processing days, provided an immediate discount on crown work and could be used in combination with her PPO insurance plan.

The broker filled out both applications for Gina, waived one application processing fee and accepted her initial payment for the plans by credit card all over the phone. The entire phone call lasted approximately 15 minutes . Gina was able to have her crown restored at a considerable savings within a few weeks and continued to use the discounts in conjunction with her PPO dental insurance plan.

*Dentalinsurance.com is owned and operated by Kelsey National Corporation. A 41-year-old, family-owned company headquartered in Los Angeles, Kelsey is an independent insurance broker that provides individualized customer service and is licensed in all 50 states.

 

Is Using a Licensed Insurance Broker for You?

The broad selection of dental care options, carriers and multitude of brokers to buy from can be confusing. If you are still deciding if using a licensed insurance broker is for you, consider the following:

Licensed insurance brokers can:

  • Provide expert advice
  • Provide product, benefit and price comparisons on a variety of available plans
  • Help you fill out paperwork
  • Save you time and money
  • Reduce the risk of fraud and misleading advertising
  • Provide continued customer service after your coverage is in place
  • Help you get the wheels in motion for obtaining dental coverage and dental care you and your family needs

When it comes to the maze of dental care choices, a licensed insurance broker may be just the right guide to help you reach your dental care goals.

Gaye Lucas is a Southern California-based freelance writer.
Kelsey National Corporation Dental Article
November 29, 2005
Contact: gayelucas@adelphia.net