supplementalbenefits.com

There are several dental care programs available in today’s marketplace. These , include Preferred provider organizations (PPOs), dental health maintenance organizations (DHMOs),  and scheduled benefit plans. Following is an overview of each:

• Preferred Provider Organization (PPO) Plans

  Patients select a dentist from a network or list of providers who have agreed to discount their fees. If employees choose to go out of next work for a dentist then the risk that they will be balance billed for an amount higher than they would pay an in-network dentist. The out of network reimbursement may be based on a fee schedule or on a UCR(also known as Reasonable and customary).

• Dental Health Maintenance Organization (DHMO) Plans

  Contracted dentists are usually paid a fixed amount (usually on a monthly basis) per enrolled family or individual, regardless of plan use. In return, the dentists agree to provide specific types of treatment to the patients at no charge and reduced fees for other types of care. These other services usually have a deductible paid directly to the dentist. Office co-pays similar to health insurance may also be charged for each dental visit.

• Scheduled Benefit Plans

  Don’t require a network of dentists and the fees are set by the plan administrator. In most cases for any procedures, other than preventive care the patient can expect to be balance billed. Based on the fee schedule the DMO should be less expensive and the PPO a little more expensive.

• Traditional Plans (also known as Fee for Service Plans)

  Have reduced agreed to fees for coverage and reasonable and customary coverage applies.
• Typical coverage like 100% for preventive and diagnostic procedures, 80% for filling cavities , periodontal, and root canals and 50% for crowns . For these plans you can choose any dentist.  This is the most expensive of the dental plans listed.