Tucked into every individual and family health plan in California are some very good dental benefits for children. Unfortunately, the health plans don’t make it very easy to identify which dentists will accept the pediatric dental insurance that comes standard for dependents under 19 years of age. If a parent doesn’t select the correct plan types from the carrier’s online provider search function, they may be given the names of dentists who will not accept the health plans dental insurance for the children.
How do I find a dentist for my child?
In a review California individual and family health plan websites in May 2015 it was virtually impossible to determine how to locate a pediatric dental and vision provider. Only Assurant, Sharp Health Plan, and Molina displayed how to find a dentist or optometrist that was covered under the health plan. Every other health plan required a phone call to member services to figure out who the providers were. Several of the service representatives just gave out the phone number of the dental or vision insurance plan they had contracted with to provide the pediatric dental and vision benefits. Valley Health Plan had me call Covered California who told me to call Valley Health Plan.
All Covered California health plans include children’s dental and vision coverage
All individual and family plans sold through either through Covered California or direct from a health insurance carrier includes pediatric dental and vision coverage as an Essential Health Benefit mandated by the Affordable Care Act. The coverage is actually pretty good. One of the most important elements is that there is no waiting period for services, even for orthodontics. Many families I’ve talked don’t even know their health plans cover dentistry and optometry for their children under 19 years old.
Children missing important dental and vision check ups
Not only is it important for families to understand pediatric dental and vision coverage in their health plans, it is equally important to guide those parents or guardians to locate an in-network provider for those services. Without this knowledge, families can pay for dental and vision services that might actually be covered under their health plan. Some children may be going without these essential health benefits because their parents are unaware that they even exist. Only Anthem Blue Cross and Blue Shield of California actually contract with dentists to offer the children’s dental coverage. All the other carriers contract with separate dental insurance plans to cover pediatric dental.
Health plans hide the dental and vision providers
Another issue for families to understand, and is not communicated by the health plans, are the various types of dental plans. Some health plans include Dental PPO coverage and others offer Dental HMO plans. With the Dental PPO plans families may get some coverage by visiting an out-of-network dentist. However, the families can minimize their dental expenses by utilizing and in-network dentist, if they can figure out how to locate one. On the other hand, if a health plan offers only Dental HMO coverage, there is no coverage of out-of-network expenses.
Getting coverage through the health plan
Consequently, it is important that families understand how to find the type of pediatric dental and vision plan offered through their health plan and then be able to locate the in-network providers. To search for a pediatric in-network dentist for some health plans you can do it right through their website. Other carriers make you go outside to another dental plan website to search for a dentist.
How do you find a list of approved dentists and optometrists?
The selection process and plan networks cited below were provided to me by the carriers themselves in response to my question, “How do parents find a dentist or optometrist in-network with their health plan?” Always verify with the provider for either pediatric dental or vision coverage for your health plan. Don’t accept the answer that “We accept all Dental PPO plans” because that just means they may be out-of-network and your costs will be higher. (Website information and links were accurate as of May 2015 but may change over time as the carriers update their websites.)
Anthem Blue Cross
- At the https://www.anthem.com/ca/health-insurance/home/overview home page:
- Select Find a Doctor search tool on the right hand side
- From the state drop down menu select California
- From the plan/network type drop down menu select Dental Prime for dentists or Blue View Vision for optometrists
- Select specialty and enter location to bring up dentists in your region
- On the home page http://www.assuranthealth.com/ , click on Current Customer menu tab
- Scroll down and under Additional Pediatric Benefits included on Metallic Major Medical Plans will be links for Pediatric Dental Benefits and Pediatric Vision Benefits
- At the https://www.blueshieldca.com/bsca/bsc/public/member/mp/home/ home page:
- Scroll to bottom of home screen and select find dentists or vision care link which will take you to the provider directory home page.
- Step 1 – Select the green button to Select Your Plan
- From the drop down menu, select your family’s type of health plan 2015 Individual and Family xPO, Do Not select a dental or vision care plan from the drop down menus.
- Step 2 – select the radial button for either Dentists or Vision Care, enter location and click “find now” button.
- The respective providers, dentists or optometrists, will be displayed on the next page. You can refine the search or specialty providers.
Chinese Community Health Plan
There is no website search on the CCHP website. They direct members to call Delta Dental at 800-422-4234 and give them your CCHP member number to locate a dentist. For vision providers they suggest calling VSP at 800-877-7195 and giving them your social security number to find an optometrist.
- From home page http://www.cigna.com/ click on find a doctor link
- On the next page select the directory for “Buying an insurance plan on your own…”
- Enter location, select medical plan type, and select Dental PPO or EPO plan.
- Click on Dentist link with tooth icon, then select Pediatric Dentists
There is no website search for pediatric dentists on the Kaiser website. They suggest calling Delta Dental at 800-589-4618. Alternately, Kaiser members can visit https://www.deltadentalins.com/. For the plan type the member should select Delta Care USA to search for dentists. Kaiser handles pediatric vision benefits at either their hospitals or clinics.
L.A. Care Covered
There is no way to search for dental or vision providers on the L.A. Care Covered website. Member services suggests calling their dental coverage provider Liberty Dental 888-700-5243 to locate a dentist. For vision coverage members should call VSP at 800-877-7195.
- At the https://www.healthnet.com/ home page:
- Select Provider Search
- Select a location to search by such as city or county, don’t enter a filter for provider or plan name -> Continue
- Select Ancillary Services -> Continue
- Select Health Plan Type either Covered California or Standard Medical Plan -> Select the Plan from the drop down menu
- Links for Dental and Vision providers will appear at the bottom of the page.
- Selecting either Optum of dental providers or Eyemed for vision providers will take you to another website to further search for the respective providers.
- On the Optum website -> Locate a Dentist
- Select Health Net DHMO CA ONLY
- The Molina has some quick links to search for pediatric providers.
- At http://www.molinahealthcare.com/members/ca/en-us/Pages/home.aspx home page
- Select Find a Doctor or Pharmacy
- Enter location, select coverage type as Molina Market Place, the links to the pediatric vision and dental providers will then appear.
- Clicking on the links will take you off the Molina website. Vision is provided by VSP and dental is provided by DentaQuest.
Sharp Health Plan
The Sharp Health Plan website offers a clear links to the pediatric dental and vision services. At the https://www.sharphealthplan.com/ home page select the Vision & Dental link. There instructions on how to select a VSP vision provider or dentist from Premier Access dental.
Western Health Advantage
There is no information on the WHA website regarding children’s dental or vision services. Member services suggested Premier Life at 866-650-3660 or visiting www.premierlife.com and selecting the DHMO dental plan to find a dentist. Pediatric vision services are offered through MES Vision and members can call 800-877-6372 to locate an optometrist.
Valley Health Plan
There is no information on the Valley Health Plan website for pediatric dental or vision services. VHP member services instruct people to call Covered California who handle their member benefits. Covered California told me to call Valley Health Plan. When I told Covered California I was instructed to call them by VHP, they gave me the numbers for the insurance plans they thought handled the pediatric dental and vision benefits: Liberty Dental at 888-703-6999 and VSP 855-868-4561.
Health plans need to do better
I’m astonished that these health plans have made it so difficult to acquire the pediatric dental and vision services that included in the health plans that their members are paying for. While children’s dental and vision services are considered Essential Health Benefits, these insurance companies and health plans have done a great job of hiding this information from their members.
Pediatric Dental and Vision Benefits
You can find a summary of the children’s dental and vision benefits inside the health plans Evidence of Coverage document. Listed below are some of the health plans that have separate literature for the pediatric benefits. Except for the plan type of Dental PPO or Dental HMO, all of the benefits are the same between plans.Anthem Blue Cross Pediatric Dental Coverage https://insuremekevin.com/download/health_net/hn_archive/hn_ifp_2015/ca_hmo_hsp_ped_dental-vision_2015.pdf https://insuremekevin.com/download/health_net/hn_archive/hn_ifp_2015/ca_ppo_epo_ped_dental-vision_2015.pdf