Insurance Plans

There are countless insurance companies in the market today, all with several different dental plans to choose from. After interviewing Kellie, the front desk expert of Dr. Thomas Kiefer’s office, I was able to compile some information about dental insurance. In this post I will introduce 3 basic plans offered by most insurance companies (they may be called different names however). I will follow up in the next post with an analysis of what these mean and how they apply to your treatment.

PPO: Preferred Provider Organization
Many insurance companies offer this coverage plan, which allows you to go to the dentist of your choice. You are rewarded for going to a dentist in the company’s network by receiving more treatment coverage. If you go to a dentist outside of the network, you are still covered, but at a reduced rate. In this case, the insurance company pays less than they would for an in-network provider, and you (the patient) end up paying the difference. You are also responsible of knowing the coverage limits (ie: how long you have to wait between visits, any co-payments, etc). By presenting your insurance card at the dentist's office, they are able to bill your insurance company for the claim. The insurance company will review the claim and pay the dentist the eligible charges. You will then be sent a summary of the actions taken by the insurance company. You are responsible to pay the difference between what the dentist charged and what your insurance paid, if applicable. The dentist office will bill you any charges so you will know whether or not you are responsible for payment.

Example: If you visit a dentist in the network you would pay the $22 deductible and the insurance company would pay the rest. If you see a dentist that is not in the network you would have to pay 30% of the entire bill. From this hypothetical situation you can see how going to an in-network dentist would save you a lot of money, especially if you had multiple trips to the dentist a year. (The numbers used are arbitrary and will depend upon your specific plan.)

DMO: Dental Maintenance Organization
Under this plan, you are required to go to a specific dentist, sometimes called your Primary Care Dentist. This dentist has to be an in-network provider. Before the insurance company will start paying for you, they must receive notification of what dentist you will be using for the duration of your time with the company. Once that dentist is approved, you can schedule appointments and the insurance will cover their share of your treatment. If you choose to change dentists, you must notify the company in advance and get the new dentist approved before they pay for the new dentist’s services. If you go to a different dentist without giving the insurance company proper notification or if you go before they agree to cover the dentist, (say it is an emergency or you forget to notify the company that you’re changing dentists) the insurance company will not cover the costs.

PDO: Preferred Dental Organization
This plan is very similar to the DMO.

The next post will discuss how to choose between these plans, and whether insurance is something you need by comparing possible costs.

Information provided by DentalInsurance.com, Delta Dental, and Kellie at Dr.Kiefer's office.