With so many dental benefit plans, you have heard this a time or two from your patients. What insurance plan should I choose to reduce out-of-pocket costs on dental care? What are the different types of dental insurance plans on the market? That is where it gets woozy, and you help your patients make informed decisions in selecting their dental insurance plans.
What is a PPO Dental Plan?
A PPO (Preferred Provider Organisations) is a flexible indemnity insurance option, where the patient can choose and receive care from an in/out-of-network dentists listed under the insurer. Dentists deliver the rendered services at set fees. Patients have the freedom to choose any dentist they would like to see for their dental care. The contracted dentists under this plan have had to accept the maximum allowable fee, whereas the non-contracted dentists can receive money either higher or lower as per the plan allowance.
What is a DHMO Dental Plan?
Under DHMO (Dental Health Maintenance Organisation) patients are allowed to contracted dentists from a specific list identified by the insurer to provide contracted services at reduced or no cost. Also known as a capitation plan. Here, the contracted dentists have remunerated a certain amount basis each patient and not for the individual services. Hence it limits the choice of dentists as very few offices work with this kind of plan. On the contrary, some providers rush through dental services for payouts. Hence, before enrollment, inform the patients about the dental insurance plans that the office accepts- an accessible alternative that does not limit the treatment and services.
Difference between PPO and DHMO Dental Plans
Let us take a closer look at PPO and DHMO dental plans to know the key differences that will be a bonus to your practice. In this article, let us compare the plan’s basis deductible, maximum amounts, coinsurance, waiting period, in/out-of-network requirement, types of services rendered, and primary dentist requirement.
Usually, patients have common questions about the benefits of each insurance plan like, is there any low deductible under my insurance plan? Does my dental insurance plan have a coinsurance benefit? What are my dental insurance plans premiums? Since these features of the dental plan vary from PPO to DHMO.
Waiting Period of Dental Insurance Plans
Whether your patient buys a dental insurance plan from their workplace or through their own by an individual carrier, still insured individuals have to wait to receive reimbursement. Some insurance companies have longer waiting periods before the insurance covers them. Unfortunately, this discourages people from getting insurance coverage benefits on the treatment once the policy expires. Preventive services such as oral exams, teeth cleaning, x-rays, sealants, and fluoride treatments are covered at 100% by both PPO & DHMO dental plans with a minimum of 3-6 months of the waiting period.
It ensures that the patient does not drop the plan, especially with complex procedures that have six months to a year waiting period. The status of waiting periods is also dependent on the provider, type of service, and dental insurance plan. Amongst other benefits, every insurance provider offers a different waiting period with diverse insurance plans.