The purpose of dental insurance is to pay a portion of costs that are associated with dental care. As with other insurances, there are several different types of plans, including individual, family or group dental insurance. Group insurance plans are grouped into three primary categories. The first is Indemnity, or dental insurance which grants you the ability to see any dentist you want who will accept this type of coverage. The second is Preferred Provide Network dental plans, or PPO’s. The third is Dental Health Managed Organizations in where you are assigned an in-network dentist and dental office. You must use the benefits in that network.
Dental offices usually have a fee schedule which is a list of prices for the dental services they offer. The dental insurance companies also have a fee schedule which is similar and usually based on “Usual and Customary dental services”. The fee schedule is used as the “transactional instrument” between the dental office, the insurance company and the consumer.
Indemnity Dental Insurance plan can be helpful when you want to keep your dentist but they do not participate in a dental network. This plan allows for the insurance company to pay the dentist a percentage of your services depending on the policy you purchased. Make sure to review the co-payment requirements, the deductible, waiting periods and annual limitations prior to deciding on a plan.
Dental Health Maintenance Organization is when a dentist signs a contract with a dental insurance company. The provider agrees to accept an insurance fee schedule and will then five their customers a reduced cost for any services provided within that network. Many of these DHMO insurance plans have almost no waiting periods. They also don’t have an annual maximum benefit limit. Often this plan is purchased in order to help defray the cost of expensive dental procedures.
Participating Provider Networks work similar to DHMO’s only it allows you to use an Out-of-network provider. If there is a difference in fees it will become the patients’ financial responsibility to cover them