Now, more than ever, there seem to be many different types of dental insurance and discount plans to choose from. It’s easy to get confused with all the terminology. Every so often, I like to review the options so that you know what to look for when you start researching coverage.
Traditional/Indemnity Plans: These plans allow you to see any dentist you choose. Your benefits are the same no matter where you go. (My office accepts these plans.)
PPOs (Preferred Provider Organizations): These plans provide a list of “preferred providers”. Most plans will let you go to someone off the list with the understanding that you might pay more out of pocket for choosing that option. A few require you to pick someone off their list for you to have any dental benefits paid. Despite the connotation, “preferred provider” has nothing to do with the quality of dental care you will receive. Instead, it means that the listed dentists have agreed to a fee schedule created by that insurance company. The fee schedule asks dentists to cut their fees by 20 per cent or more—in some cases, this may lead to a reduced level of care (such as cheaper materials) simply because the dentist cannot afford to maintain high standards within the mandatory fee schedule. (My office accepts many of these plans and if we are not already a member of your plan, we are glad to request information to determine if we can become a participating provider.)
DMOs/HMOs (Dental Maintenance Organizations/Health Maintenance Organizations): These types of plans require you to pick a general dentist from their list of providers. If you do not pick one, the company will assign you to one. Your insurance will only pay if you go to this office. If you need the services of a dental specialist, your assigned general dentist must refer you to a specialist who also is in the DMO/HMO network. The providers on the network list have agreed to accept a reduced fee schedule set by the insurance company. The fee schedule cuts fees by more than 20 per cent. In some cases, this may lead to a reduced level of care (such as the use of cheaper materials) simply because the dentist or office cannot afford to maintain high standards within the mandatory fee schedule. (My office does not accept most of these plans. There are a few through Medicare that have HMO in the name that we do participate with.)
Capitation: This type of plan requires you to pick a general dentist from their list of providers. If you do not pick one, the insurance company will assign you to one. The difference between this and a DMO/HMO is that often the dentist to whom you are assigned gets a monthly fee from the insurance company for you or your family whether you go to the office that month or not. These plans may not cover many dental services (which may affect your decision to go ahead with recommended treatment). If you need the services of a dental specialist, your assigned general dentist needs to refer you and you need to go to a specialist who is part of the capitation network. Because the dentist gets paid monthly whether you ever use his/her services or not, the office’s incentive to follow up with you for missed treatment etc. may be less than with other types of insurance plans. (My office is not part of any capitation plans.)
Discount Plans: Discount plans are not really dental insurance. In most cases, you pay a company for the right to use a discounted fee schedule. When you go to a dental office that participates with that discounted fee schedule, you pay for your treatment with your own money, just at the rate of the schedule you chose. (We do participate with some independent discount plans as well as having our own--see below!)
Some offices have developed their own version of discount plans. For example, I offer a preventive care plan. You pay a fee to enroll BUT the big difference between this and a traditional discount plan is that the enrollment fee includes your 2 dental check up appointments. (rather that those being an additional fee to you). Any other treatment within the year receives a discount off the regular fee.
I hope this information helps you to choose a dental plan.
*Note: Information in this article is not meant to replace the clinical or professional judgement of your healthcare and insurance professionals.
Dr. Jennifer Robb is a general dentist who is accepting new patients at her office located at 1612 Cooper Foster Park Rd., Lorain, OH 44053. Call 440-960-1940 to schedule your appointment. www.drjrobb.com or find us on Facebook at www.facebook.com/DrJenniferRobb