Dental/Vision/Hearing

[somarco]

707, I don't push any dental plans. They are all ripoffs. If someone wants to buy, I don't talk them out of it any more. Here are the links, you decide.

Dental plans generate more complaints than almost any other line of coverage.

Most agents have no clue how dental plans work and don't care.

Most have waiting periods, caps on how much they will pay in a year, deductibles, etc.

People don't need dental insurance for routine work. If you have to wait a year to get a crown, what good is that?

DHMO plans offer the best value for individuals, DR for groups.

Either it is a fit or not.

 

[The Brokerage Resource]

Carriers establish their own R&C guidelines then set up their formula based on that.

If a procedure is $1000 according to their R&C and they want to pay in the 80th percentile and the coinsurance is 80% then they would pay $1000 x .8 x .8 = $640 for what they consider to be reasonable.

If the dentist bills $1400 then the plan pays 45% of the actual bill.

Wow, you need understand the products your selling.

80% percentile means that in the zip code your client is having the work done the carriers R&C will be = or higher than what 8 out 10 dentists charge for the procedure. 90% percentile means 9 out of 10.

So if you go to the a dentist who charges in the middle of the range and the procedure is $100 and the procedure is covered at 80% the carrier pays $80.00. If you go to the most expensive dentist in your area and he charges say 20% higher
than the 80% percentile rate which is $ 100.00 than the bill would be $120.00 the carrier pays $80.00 and the client pays 60.00

The R & C rates the carrier use are usally provided by a 3rd party like Ingenix.

 

[texaslady]

Wow, you need understand the products your selling.

80% percentile means that in the zip code your client is having the work done the carriers R&C will be = or higher than what 8 out 10 dentists charge for the procedure. 90% percentile means 9 out of 10.

So if you go to the a dentist who charges in the middle of the range and the procedure is $100 and the procedure is covered at 80% the carrier pays $80.00. If you go to the most expensive dentist in your area and he charges say 20% higher
than the 80% percentile rate which is $ 100.00 than the bill would be $120.00 the carrier pays $80.00 and the client pays 60.00

The R & C rates the carrier use are usally provided by a 3rd party like Ingenix.

Thank you for posting this!
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No, they actually said that because this is a limited benefit plan that they just pay what the dentist or provider charges, they'll only use R&C if the dentist or provider is way out of line. From the two claims I submitted, they paid on what the provider billed. My dentist isn't cheap and they have paid based on what he billed. I use Ameribest for my vision and Ameribest is pretty reasonable. Again, they just paid the claim based on what was charged.

I know most dental/vision plans don't do this, that is one of the reasons why i really like this plan, on top of the fact that they can go to any provider they like. It's not a network based plan.

If you have clients that need fillings, tooth extraction, dental exams, x-rays, eye exams, hearing exams those service are covered at 60% immediatly during the 1st year.

Somarco, I've noticed that you always kind of bad mouth any dental plan that's brought up on this site but never mention who you use. When I brought up UCT in a previous post you brought up this whole thing about R&C and the percentile that the insurance company is using...to be honest that is one of the reasons why I took out the plan myself, to see what they actually paid. Also, I needed the coverage anyways. I was pleaseantly suprised to see the company just paid based on the claim, they didn't use R & C. I wanted to pass the info onto other agents. I also was wondering if Medico did the samething. So just out of curiousity, what wonderful dental plan are you showing your clients, because you don't seem to ever bring one up. Have you taken this plan out on yourself to see how it pays?

....nevermind..i looked at your website and see what you're offering..hmmmmm

this is you right? Senior Dental Insurance Plans - Medicare Dental Insurance

Can you direct me to a brokerage with whom I can become appointed to sell UCT? Also, is it guaranteed issue and do the premiums go up with age?

 

[somarco]

I worked for a dental carrier a few years ago. Believe I do know a little bit about the way the game is played.

Some carriers will use an outside source, such as Ingenix, some not. Carriers that also have a PPO or DHMO product usually develop their own criteria.

When a policyholder uses a non-par dentist, if there are any benefits at all, the percentage paid is applied against the negotiated rate in that area.

Percentiles come in to play in designing the product and premium. I have seen carriers that offer almost identical plans but with significantly different pricing.

One pays 80% of "R&C" while the other plan pays 70%.

Of course most folks would never know that unless they had access to actuarial data.

Dental insurance is a ripoff. Always has been. Always will be. Especially in the individual products.

DHMO's and DR would be the exception.

If you go to the most expensive dentist in your area and he charges say 20% higher
than the 80% percentile rate which is $ 100.00 than the bill would be $120.00 the carrier pays $80.00 and the client pays 60.00

Which means the plan pays 66% of the actual bill.

Yeah, that's a real sweet deal.

 

[Hopwood04]

I prefer Medico.

 

[insurance0707]

Thank you for posting this!
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Can you direct me to a brokerage with whom I can become appointed to sell UCT? Also, is it guaranteed issue and do the premiums go up with age?

Ritter is a good brokerage to go through for the UCT plan. The policy is guarantee issue and the premiums do not increase with age. The plan is guaranteed renewable and is available to ages 18-84. For those 84, the plan will continue when they turn 85, it's a guaranteed renewable plan.

I don't think this plan is a "rip off" otherwise I wouldn't have taken it out myself. Also, they are paying the claims based on the actual charges, which is nice. Your clients can choose from a $750 plan, $1,000 plan, $1,500 plan or $2,000 plan.

 

[The Brokerage Resource]

We are a Medico FMO if your interested, we do not have a UCT contract and if Ritter does they would be a good choice.

 

[insurance0707]

We are a Medico FMO if your interested, we do not have a UCT contract and if Ritter does they would be a good choice.

Have you seen how this plan pays. I was interested in it also because the rates are lower but I wasn't sure how they paid their claims, if they used the amount the dentist bills or a different amount. The Medico plan and UCT plan are almost identical, except UCT offers a $0 deductible and 4 different benefit options where Medico only offers 2 different options for maximum benefits

 

[jdeasy]

Wow, you need understand the products your selling.

80% percentile means that in the zip code your client is having the work done the carriers R&C will be = or higher than what 8 out 10 dentists charge for the procedure. 90% percentile means 9 out of 10.

So if you go to the a dentist who charges in the middle of the range and the procedure is $100 and the procedure is covered at 80% the carrier pays $80.00. If you go to the most expensive dentist in your area and he charges say 20% higher
than the 80% percentile rate which is $ 100.00 than the bill would be $120.00 the carrier pays $80.00 and the client pays 60.00

The R & C rates the carrier use are usally provided by a 3rd party like Ingenix.

That's not exactly how it works. When a company uses the percentile factor for what they consider reasonable and customary they will pay their % based on what ever that is unless it's less for them to do so.

In your example if the R&C is $100 and the % paid is 80, the plan would pay $80 and the client would pay $20. If they went to the doc charging $120, the plan would still $80 and the client would pay $40.

If they went to a dentist that charged $80, the plan would pay $64 and the client would pay $16.

Maybe that's the same thing you saying, but the math was wrong?

Who bases their R&C on the 80th percentile? Most I've dealt with use the 50th percentile to set the R&C.

 

[The Brokerage Resource]

That's not exactly how it works. When a company uses the percentile factor for what they consider reasonable and customary they will pay their % based on what ever that is unless it's less for them to do so.

In your example if the R&C is $100 and the % paid is 80, the plan would pay $80 and the client would pay $20. If they went to the doc charging $120, the plan would still $80 and the client would pay $40.

If they went to a dentist that charged $80, the plan would pay $64 and the client would pay $16.

Maybe that's the same thing you saying, but the math was wrong?

Who bases their R&C on the 80th percentile? Most I've dealt with use the 50th percentile to set the R&C.

No, your are confusing two different things. If the R&C is 100.00. The 80th percentile means 8 of 10 dentists will charge $100.00 or less for that procedure 90th percentile means 9 out of 10 dentists will charge 100.00 or less.

The plans do have different % for covered charges.

Thats the 100-80-50 part, so the plans will pay 100-80-50% of the charges bases on the percentile and R&C amount.

So long as you go to a dentist who charges in the middle of the range you should only be responsible for the plan % of the
covered charges.

We have a pretty big block of dental business and to be honest the 80-90% Percentile concern is way over blow and almost never causes issues. I have yet to see a plan that pays at the 50% percentile and I would never reccomend a broker sell that.