Dentistry Insurance Basics
There are different types of dentistry insurance plans. The most common type is a dental PPO, or Preferred Provider Organization. Other types of plans include an indemnity plan and an HMO plan. The main differences concern out-of-pocket expenses, choice of dentists and how bills are paid. These are things to consider when choosing a dental plan.
Dental PPO
- A dental PPO requires a deductible.
- This type of plan typically maintains a network of dental providers. The dentists in the network have agreed to reduced rates with the insurance company. When using a network provider, the patient usually pays a percentage of the reduced rate, and the insurer pays the remaining.
- A patient may use a dentist outside of the PPO network, but the amount reimbursed will be based on what a network dentist would accept as payment in full. Thus, the patient’s responsibility may be a greater portion of the bill.
- The dentist’s office usually submits the claim on the patient's behalf.
- Using a dental PPO means less paperwork, lower out-of-pocket expenses and a broad choice of dentists.
Indemnity Plan
- With an indemnity plan, a patient may have to pay upfront for services, then obtain reimbursement from the dental plan. This plan reimburses for covered services after they receive a bill.
- An indemnity plan offers the freedom to select any dentist. Though referrals are typically not required, some plans may require the patient to obtain preauthorization for some procedures.
- Some plans require a deductible.
- Once the deductible is paid, the insurer will typically pay the customary and reasonable rate for covered services.
Dental HMO Plan
- HMO dental plans use a select group of dental providers.
- They offer less expensive monthly premiums, but the patient has less freedom choosing a dentist.
How to Determine the Best Dental Plan
- Consider the following when making a decision regarding a dental plan: monthly cost, deductible, how much the plan will pay once the deductible is met, choice of in network dentists, how much you pay for out of network dentists and waiting periods for certain dental procedures.