Learn something new every day
More Info... by email
Dental benefits plans are often categorized much like health insurance plans, with insurance being offered as indemnity plans, dental health maintenance organizations (DHMOs), or a dental preferred provider option (DPPO). The plans may also have different formulas used for paying claims that may also help define them. These dental benefits are usually referred to as dental insurance, but in some cases may be nothing more than cooperatives or discount plans.
One of the most common types of dental plans is the indemnity plan, also known as a fee for service plan. In this type of dental insurance plan, the patient has the greatest flexibility in choosing a provider he feels will best meet his needs. Often in these cases, the patient must pay the dental bill up front, and then get reimbursed from the insurance company for dental benefits. Claims are often paid minus the deductible, and could be paid in full or in part.
In a DPPO plan, the patient has some of the same flexibility, but may pay more for it. In these plans, the patients receive the greatest value in dental benefits when they go with a network provider. If the dentist they want to see is outside the network, the plan will still likely pay some dental benefits, but will not pay as much as it would to a provider from within the network.
A DHMO plan offers the patient, or policy holder, the least amount of flexibility. Like DPPOs, there will be a certain group of in-network providers that patients may choose from. Unlike DPPOs, where patients have the option of going outside the network and still receiving some benefits, that is not the case with a DHMO. Going outside the network often means the DHMO will not provide any dental benefits.
Discount plans are not really an insurance product, but many consumers may get them confused. In a discount plan, the goal is to find a group of providers who agree to discount their services for referrals from the plan. That leads to a direct benefit for the patient, but may not always be a good choice. Discounted plans may not be subjected to the same regulations and standards as traditional insurance companies.
For traditional insurance plans, the claim amount being honored could depend on the type of pay scale the insurance company uses. Some may pay in full, but typically others use a standard such as charging fees that are "usual, customary and reasonable", or using a set table of fees. Fees that are usual, customary and reasonable take into account geographic differences, and look at what other local providers charge. If the insurance company does not honor the total claim, the patient often must make up the difference.