If you are like most people, you probably do not spend a whole lot of time thinking about your dental insurance. Besides, reading the fine print of your insurance policy can be time-consuming and confusing. However, understanding at least the basics of how dental insurance works can be very important. Indeed, having a grasp of the nuts and bolts of your insurance plan can not only help you maintain a healthy smile but also save you money! Want to learn more? Here are three things every person should know about dental insurance.
1: PPO vs DHMO: What’s the Difference?
There are two main types of dental insurance plans: Preferred Provider Organization (PPO) and Dental Health Management Organization (DHMO). Knowing which type of plan you have can help you choose the right dentist and keep out-of-pocket costs low. Here is what you should know about PPOs and HDMOs:
- PPO Plans: This type of insurance plan is known for its flexibility. If you have a dental PPO, your insurance provider will likely provide you with a list of in-network dentists that accept your plan. You can choose to visit a dentist who is out of network, but your out-of-pocket costs may end up higher.
- DHMO Plans: If you have a dental HMO plan, you can choose from a network of dentists that accept your plan for a set co-pay or no fee at all. Although DHMOs are often very cost effective, you may not be permitted to see an out-of-network dentist.
2: Know What’s Covered
Understanding at least the basics of how your dental insurance plan works will help you get the most out of your investment. Although every plan is slightly different, must insurance providers follow the 100-80-50 coverage model:
- 100% of Preventive Services – Routine dental exams, cleanings, and fluoride treatment.
- 80% of Basic Services – Dental fillings, simple extractions, and root canals.
- 50% of Major Services – Crowns, bridges, and dentures.
3: How to Seek Reimbursement
When it comes to dental insurance reimbursement, your insurance company will likely reimburse you quicker than they would your dentist. You are the one paying them a monthly premium, after all!
There may be some dental treatments in which you will need to pay your dentist in full and then wait on your insurance to reimburse you directly. Just remember: you are their favorite! In addition, thanks to electronic submission systems, your reimbursement will likely arrive in just a few short weeks.
Many reputable dental practices have knowledgeable staff that can file insurance claims on your behalf and walk you through the steps you need to take to receive reimbursement. If you have any questions or need assistance in this regard, do not hesitate to ask your dental team!
Now that you know a little more about how your dental insurance works, do not hesitate to take advantage of your coverage and visit your dentist!
About the Author
Dr. Sujal Patel provides quality dental care in a comfortable, welcoming environment at Coco Dental in Dallas. He is in-network with most major PPO dental insurance plans, including Aetna, MetLife, Cigna, Delta Dental PPO, and many more. To learn more about how to take advantage of your dental insurance benefits, visit the Coco Dental website or call Dr. Patel’s knowledgeable team at 972-629-9339.