Dental plans are insurance programs that provide coverage for dental treatment. It helps dental patients to overcome financial losses due to expensive dental treatments and enables them to take necessary and quality dental treatments.

You should choose dental plans that are compatible with health plans to eliminate gaps or overlaps. Insurance companies including Delta Dental, Metlife, and Blue Cross and Blue Shield, to name a few, offer a variety of options tailored to each corporation’s needs.

There are many ways to design a dental benefit plan. Although the individual features of plans may differ, the most common designs can be grouped into the following categories:

• Direct Reimbursement Programs: In Direct Reimbursement Programs, patients are reimbursed just a certain percentage of the amount spent on dental care, regardless of treatment category. Under the insurance scheme, patients pay the bill amount and submit paid receipt or proof of payment to the insurance company.  This method typically does not exclude coverage based on the type of treatment needed. Patients are also allowed to go to the dentist of their choice.



• “Usual, Customary and Reasonable” (UCR) programs: In UCR programs, patients can visit any dentist for dental treatment. These plans pay a set percentage of the dentist’s fee or the plan administrator’s “reasonable” or “customary” fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called “customary”, they may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of government regulation on how a plan determines the “customary” fee level.



• Preferred Provider Organization (PPO): In Preferred Provider Organization, patients are discounted on their bills as an incentive by the contracting dentist.

Insurance coverage and payment options:

There are basically three ways for insurance coverage and payment option.

• Most insurance companies give the insured the option to pay their dentist in full and get reimbursement for the amount covered.



• Some dentists require the patient to pay the full amount and get reimbursement by their insurance companies.



• Some dentists accept only the deductible and co-payment from the patient therefore it is advised to ask the dentist if they require full payment or if they accept payment from insurance.
  

In case my new office is “out of network” with my new plan, what option do I have?

Very often when you join a new office, it may not be on the list of pre approved practices for their dental plans. In most cases these offices still accept their particular type of insurance however the benefits may slightly be reduced. However, each insurance company, and each plan within the company, differs and therefore it is imperative to check with your insurance company to verify that you can see an “out of network” provider.

What is DMO or a DHMO?

A Dental Maintenance Organization (DMO) provides dental care from a network of dentists, generally emphasizes preventive services, and covers eligible services at 100% minus a specified co-payment, and does not require the completion of claim forms. An HMO only covers dental care services which are authorized in advance by an individual’s primary care dentist. These plans are similar to DMO or DHMO plans that are usually accepted by very large dental clinics or dental offices that just opened up.

What are the differences between a DMO and an indemnity dental plan?  

A Dental Maintenance Organization (DMO) only provides care from a network of dentists which is authorized in advance by an individual’s primary care dentist. An indemnity dental plan enables participating members to receive care from any licensed dentist. Members are required to submit claim forms and the plan has deductibles and co-insurance.