Dental Insurance (Dental Benefit Plans)

There are many different kinds and types of Dental Insurance Plans. More correctly referred to as Dental Benefit Plans, these plans can be confusing, frustrating, and difficult to deal with. There are indemnity, PPO, HMO, and discount dental benefit plans.

Indemnity plans or Traditional Insurance plans reimburses it’s members or dentists at the dentist’s Usual, Customary and Reasonable fee (UCR). These plans allow the subscriber to go to any dental office with out being limited to a panel.

PPO, or Prefrred Provider Organization, is the most common form of benefit plans. PPO’s provide members with a list of participating dentists to choose from. These dentists have agreed to a lower fee schedule, which provides the patient with a greater cost savings. Most PPO’s pay 50% on major treatments, 80% for basic care,  and up to 100% for preventative care. These plans usually have maximums around  the $1000 – $1500 mark. Once the PPO has paid out their $1000 maximum, they will no longer cover treatment for that year.  At this point, the client must cover their own dental expenses.

HMO‘s are capitated or prepaid insurances. HMO’s were designed to provide members with basic care at the lowest rate. Participating HMO providers receive a monthly capitation check for the total number of people assigned to the office. This amount is only a few dollars and is intended to offset the administrative costs. HMO’s generally do not pay for any services rendered. Fees are usually greatly reduced, but it is the client who is solely responsible for paying the doctor. An odd thing about HMO plans is that the doctor earns the most by doing the least amount of treatment.

At Saremi Johnstone Dentistry, we do our best to help you maximize your dental benefits, and to minimize your out of pocket costs. Dental benefit plans can be confusing, but we are here to help.

We look forward to seeing you soon!