Why Have Dental Insurance?
Discount or Referral Plans
Traditional and Indemnity Insurance
Capitation Dental Plans (DHMO's)
What Does My Plan Cover?
Preferred and Exclusive Providers
Get the Most out of Your Insurance
Choosing a Plan
Where Can I get Insurance?
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Preferred and Exclusive Provider Organizations Similar to a DHMO A Preferred Provider Organizational plan or PPO is similar to a DHMO. They often operate under a closed panel. You have no choice which dentist you want if he is not on their list, if you want the discount payment price. But always remember, if you do not see your dentist on the list; ask him if he participates as insurance companies pick up new dentists all the time. Networking PPOs have a network of dentists that work with them. The insurance company contracts with the dentist to provide care for their customers. The insurance company then refers patients to the dental clinic or individual dentist. In turn the dentist agrees to discount the fees it submits to the PPO. Payments & Fees Because the dentist agrees to discount the fees for services upfront to the insurance company this equals savings to you. The discounted fee is usually lower than the UCR the insurance company would use to calculate payment. If you have a co-pay then your portion is for your percentage of the discounted fee. Hopefully the dentist accepts the loss of the difference; you will definitely want to make sure of this before choosing. A good example is – you need a tooth pulled and Dr. Smiley’s regular fee is $75.00. Under your PPO, the discounted fee is $50.00. Your insurance covers this procedure for 50% of the cost. Your portion of the fee is $25.00; the dentist may or may not accept the loss of the extra $25.00 he would normally charge. Deductibles, Etc. Like most other insurances this type of plan has deductibles, monthly premium payments and can have you sharing a percentage of the fees. Again, like DHMOs your premium may be lower than if you were in a traditional insurance situation. There is no paperwork for you to file here either. Like other insurances, a PPO will most likely cover the cost of preventive care 100%. Be Careful This is another situation where because the dentist could loose profits your care can suffer. While not quite as risky as a DHMO, you will still want to double check who you choose and the quality of service and care they offer. Another good question is how hard is it to get an appointment. The same situation applies here as it does to a DHMO, you may not be covered for emergency or out of town treatment. There are a few PPOs who will allow you to choose providers outside their list but the cost will reflect that choice. Exclusive Provider Organization An EPO is almost identical to a PPO except you have no option of who you go to at all. You have to go to their provider. Specialized care can be limited in this case. Both PPO and EPO plans may limit the number of times a year you can see your dentist. Many dentists will not even participate in this type of insurance plan. feedback@DentalInsuranceLocators.com |
