Dental Insurance Plans: What They Are and How

They Work

Newly licensed dentists have many things to think

about before starting their dental practice. One of

these is dental insurance.

Dental insurance helps patients pay only a portion

of the costs of dental care. There are different

types of dental insurance, but they usually fall

under three primary categories: Dental Health

Managed Organization (DHMO) plans, Preferred

Provider Organization (PPO) dental plans, and

indemnity dental insurance plans.

DHMO Plans

Patients with a DHMO plan receive all dental care from the providers in

their plan’s network. They select a primary care dentist who provides

their dental care and who refers them to specialists if needed. When

patients need a dental service, they are required to visit their primary

dentist first. There is little or no paperwork needed in this plan, as

patients just need to pay their co-payment or deductible, if they have

one. Dentists who sign a contract with a dental insurance company agree

to accept insurance fee schedules and give customers a reduced cost for

dental services.

PPO Plans

Patients who have PPO dental plans can choose dental care providers inside or outside their plan’s

network. They do not need to choose a primary dentist, or get referrals just to see a specialist. If they

choose an out-of-network dentist, however, they need to pay higher costs. There is not much

paperwork in a PPO if patients stay in-network, but if they choose to go out-of-network, they may have

to pay the dentist in full and submit the claim to their insurers for reimbursement.

Dentists who join a PPO agree to accept a fixed PPO dental plan fee and will have a steady stream of

patients. They just need to choose a provider with good reimbursement rates for services they render to

members.

Indemnity Dental Insurance

With an indemnity dental insurance plan, patients can

choose a dentist they want and do not need a referral to

visit a specialist. The patient’s insurance company will pay

the dentist a percentage of their services, according to the

policy they purchased. As there is no network of providers

in this type of plan, patients will be responsible for the

deductible and co-insurance of the services they use. Most

indemnity dental insurance plans also have an annual

maximum benefit.

Dentists who provide services to patients with indemnity dental insurance plans will be paid upfront for

the services they provide.

It is important for dentists to understand the different types of dental plans their patients may have.

This helps them provide the right services, know how to work with insurance companies, and receive

the PPO dental plan fees they deserve.

Resources:

http://www.everestadvocate.com/ppo-insurance-plans/

http://www.ada.org/2620.aspx

http://www.webmd.com/oral-health/guide/dental-health-insurance