dental insurance / dental plans

B) Table of Allowances dental insurance plans. These dental insurance policies utilize a list that outlines the dental procedures covered by the plan. Each procedure on the list has associated with it a set dollar amount that the plan will pay when that particular service is required. Usually the fee found on the insurance company's table is less than the dentist's charges. In these cases the patient pays the dentist the balance.

2) Managed Care Dental Insurance Plans. Capitation Dental Plans (Dental Health Maintenance Organizations). Preferred Provider Organization ("PPO") dental insurance plans. Exclusive Provider Organization ("EPO") dental insurance plans.

A) Capitation Dental Plans (Dental Health Maintenance Organizations). A capitation dental insurance plan (such as a dental HMO) is an arrangement where a dentist (or dentists, dental office, dental clinic, etc...) is contracted to provide dental treatment for the dental plan's enrolled members. The provider dentist is paid, usually monthly, a fixed amount per individual who has chosen them to provide their dental treatment. In return it is the dentist's obligation is to provide any and all needed dental treatment for these individuals (as specified by the conditions of the dental plan) during this time frame. The conditions of each capitation insurance plan will vary but often some dental treatments (exams, cleanings, x-rays) are provided at no charge to the covered individual, while other dental procedures (dental crowns, bridgework, dentures) require a co-payment. Because there is a negotiated arrangement between the dentist and the dental insurance company, dental capitation plans (dental HMO's) specifically are a "closed panel" type of dental plan. At the extreme, you may only have a single dental office or clinic to choose from when seeking dental treatment. Unlike a fee-for-service (indemnity) type dental insurance plan where the providing dentist is paid for each and every dental procedure they perform, with a capitation plan the providing dentist is paid a set amount regardless of how much or how little dental treatment they provide. This implies that it is in the dentist's best financial interest to help their patients achieve and remain in good dental health. This way the dentist will only need to provide a minimal amount of dental treatment. As a result their bottom line will be enhanced. Of course knowing that the dentist is paid a set amount per plan member regardless of how much dental treatment is provided should bring some other questions to your mind. What is the reputation of the dental plan? Are there individuals you can ask about how they interpret the care they have received? Did it seem that a full range of treatment options were offered to them as a remedy for a particular dental problem or that just the quickest, cheapest fix was suggested? Another concern with a capitation plan is that the amount of dental treatment an enrolled individual requires may exceed the amount the dental insurance company has paid the dentist to provide this treatment. In this instance the more dental treatment the dentist performs the more money they will loose. Since the dentist is paid the same amount no matter how much treatment they provide for plan members (although obviously they must provide enough treatment to keep the dental insurance company happy) the dentist may make access to dental treatment difficult. What are other's experiences with the plan? Are dental appointments readily available or are they backlogged and hard to get? And finally, since capitation dental plans utilize a "closed panel" of dentists you must evaluate what remedies will be available to you for those times when you require dental treatment when you are way from home and out of the area serviced by your dental plan.

B) Preferred Provider Organization ("PPO") dental insurance plans. Dental Preferred Provider Organizations (dental "PPO"'s) are a "closed panel" type of dental insurance plan. The insurance company contracts with dentists so to form a network of treatment providers. As a part of the negotiation with the dental insurance company the dentist, in return for being included in the network and hopefully receiving an increased patient load, has agreed to discount their fees. The covered members of the dental plan must select from this list of network providers when choosing a dentist. Of course the terms and conditions of each PPO type dental insurance plan will vary but in general you might consider a PPO plan to be a hybrid between a capitation plan (a dental HMO) and a traditional indemnity dental insurance plan. Similar in nature to a dental HMO, a dental PPO will encourage you to select your treatment provider from a network of participating dentists. If you do so the dental plan will probably provide its maximum benefits. As an alternative, and somewhat similar in nature to the traditional indemnity dental insurance plan, some PPO's will allow you to receive dental treatment from a dentist who is not a member of their network (a "non-participating" dentist). The trade off is that if you do so you will be penalized with a lower level of plan benefits (higher deductibles and co-payments).

C) Exclusive Provider Organization ("EPO") dental insurance plans. Exclusive Provider Organizations (dental "EPO"'s) are another form of "closed panel" dental insurance plan. They are similar in nature to dental PPO's with the exception that you are offered no option other than receiving your dental treatment from a dentist who is a member of the dental insurance company's network of providers.