Insurance & Employee Benefits
A dental health maintenance organization is occasionally referred to as a capitation dental insurance plan. It is a type of insurance where a group of dentists, or a single dentist, joins in a contract with the DHMO to offer dental treatment for the patients who are a part of the DHMO. The organization pays the dentist a certain amount per patients per month who are enrolled in the group. However, some carriers may implement a fee-
An exclusive provider organization is a network of dentists that are united with the insurance company to provide care at a reduced cost. In return, the EPO pays most of the cost of the patron’s dental care needs. An EPO is a closed dental plan, so customers can only visit the dentists that are in the plan so it differs from the PPO in that regard. Generally, an EPO does not pay the dentists until services have been rendered for the customers.
A Dental point-
A preferred provider organization dental plan is dental coverage that is part of a network insurance system. Dentists sign up for the PPO network hoping to acquire more patients. The dentists offer lower rates for the clients of a particular dental insurance carrier, in return for the referrals the insurance company provides. Patients have the choice of choosing from a network of specific dentists, or seek dental care out of the network. However, choosing out-
By William F. Schaake, CIC, CRM, CLCS © 2007
Understanding Dental Insurance Plans
An indemnity dental insurance plan is often called a traditional dental coverage plan or a fee for service plan. In this particular type of dental insurance plan, you have the choice to visit any dentist or dental care professional you wish. Generally, you do not need to select your dentist from a list of network providers or approved providers to qualify for benefits and coverage.
Normally, you will need to pay a deductible on your indemnity dental insurance. Once the deductible has been satisfied, the insurance carrier will cover a portion of “usual and customary” dental costs. How much your dental insurance will reimburse will differ according to the carrier. However, many insurance carriers offering this type of plan could possibly pay up to 100% of usual and customary dental costs.
Dental services will usually fall into one of four types. Occasionally implantology will fall into a fifth category. Here is a list of the four types and some examples of what falls into their respective categories:
Type I (Diagnostic and Preventative)
Type II (Basic)
Type III (Major)
Type IV (Orthodontics)
Popular Dental Carriers