Dental Plans & Insurance
Dental health has become an important part of overall well being. Every year more clues are discovered as to how oral disease relates to other disorders. It is financially helpful to have some form of dental coverage to minimize the costs of dental care. Insurance companies including Delta Dental, Metlife, and Blue Cross and Blue Shield, to name a few, offer a variety of options tailored to each corporations needs. Though many companies pre-approve their own employees? Dental plans, it is helpful to have a working knowledge of what your company’s plan can provide you. Delta Dental, Metlife, and Blue Cross and Blue Shield, to name a few, offer a variety of options tailored to each corporations needs. Though many companies pre-approve their own employees’ dental plans, it is helpful to have a working knowledge of what your company’s plan can provide you. If you currently do not have a dental insurance plan, click here or subscribe to our newsletter below for updates as we research some of the best dental plans available:
More Information about Dental Plans & Insurance
Insurance coverage and payment options:
Most insurance companies give the insured the option to pay their dentist in full and get reimbursement for the amount covered. However, some dentists will accept only the deductible and co-payment from the patient at the time of service; therefore, it is smart to ask the dentist before the appointment if they require full payment or if they accept payment from insurance.
What if the office that I go to is “out of network” with my new plan?
Most patients find that their current office may not be on the list of pre approved practices for their dental plans. In most cases these offices still accept their particular type of insurance, though their benefits may slightly be reduced. For instance, if the patient were to visit an “in network” provider, their yearly maximum for services may be $2000. This might be reduced to $1500 were they to visit an “out of network” provider. Each insurance company differs, as well as each plan within the company, and therefore it is imperative to check with your insurance company to verify that you can see an “out of network” provider.
What is DMO or a DHMO?
A Dental Maintenance Organization (DMO) provides dental care from a network of dentists, generally emphasizes preventive services, and covers eligible services at 100% minus a specified co-payment, and does not require the completion of claim forms. An HMO only covers dental care services which are authorized in advance by an individual’s primary care dentist. These plans are similar to DMO or DHMO plans that are usually accepted by very large dental clinics or dental offices that just opened up.
What are the differences between a DMO and an indemnity dental plan?
A Dental Maintenance Organization (DMO) only provides care from a network of dentists which is authorized in advance by an individual’s primary care dentist. An indemnity dental plan enables participating members to receive care from any licensed dentist. Members are required to submit claim forms and the plan has deductibles and co-insurance. There are many ways to design a dental benefits plan. Although the individual features of plans may differ, the most common designs can be grouped into the following categories:
Direct Reimbursement Programs:
Reimburse patients a percentage of the dollar amount spent on dental care, regardless of treatment category. This method typically does not exclude coverage based on the type of treatment needed and allows the patient to go to the dentist of their choice.
“Usual, Customary and Reasonable” (UCR) programs:
Allow patients to go to the dentist of their choice. These plans pay a set percentage of the dentist’s fee or the plan administrator’s “reasonable” or “customary” fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called “customary”, they may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of government regulation on how a plan determines the “customary” fee level.
Preferred Provider Organization (PPO):
Preferred Provider Organizations (PPO) are plans which contracting dentists agree to discount their fees as a financial incentive for patients to select their practices.