BASICS
We have a limit of $3,300 per year for dental work. Cleanings and exams don't count in that sum. When most dental work is done you pay 20%. When work is being done that will cost more than $200 your provider must get a pre-determination, that is, permission to proceed. The dentist has to send appropriate x-rays and other proof that the work is needed. If they don't there is a possibility that it will not be covered.
Dentemax Providers
When you use a Dentemax provider you are more likely to avoid nasty out of pocket expenses. For instance, if you have work done with a Dentemax provider and get charged $600, but MMO decides the Dentist should only get $450, you pay 20% of $450 ($90) and go on your merry way. If you do not use a Dentemax provider, then you pay the same $90, but then you could get billed by the dentist for balance of what was not covered. In this example the dentist got $90 from you, and $450 less $90 from MMO ($360), but can charge you another $150 to get their fee up to $600. You pay $240!
Members who feel more comfortable with a dentist they have had for years think it is worth it to have someone they want, even if it costs more, but if you are shopping for a dentist you might consider looking for someone in network. Check out the www.medmutual.com to find a dentist (or any other doctor)
Orthodontia
There is a $3,300 per mouth limit on orthodontia. This is not by incident, it is by mouth. So, if your kid needs braces twice it doesn't matter - $3,300 limit. Of course, that is also a 20/80 split, so you can't get up to a $3,300 maximum until you get charged $4,125 (since 80% of that is $3,300). Believe it or not this is still a pretty good coverage. If you are planning orthodontia it is really worth your while to look into a flex spending account (see our article)