Settling on a dental payment plan that best anticipates possible procedures or difficulties that might arise during treatment can be daunting. Knowing your particular situation and health of your teeth is perhaps the first step to consulting your preferred provider option.
The plan should be fully detailed, outlining the overall price, particulars of the specific services to be covered and the upfront cost that you are likely to pay for any dental procedure. The visit frequency is also important in calculating and working out your plan.
Do you know your plan network?
Dental care costs vary considerably depending on your dental care cover. Your options may include an Exclusive Provider Organization (EPO), Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Dental Maintenance Organization (DMO), Point of Service (POS) and a Discounted Fee-for-Service.
- Exclusive Provider Organization (EPO)
With this plan, you get to choose your preferred dental care provider-from practitioners to specialists to outpatient facilities. To gain better insight, research the provider network on the how efficiently they can meet your needs.
This package is, however, limited to in-network providers, sometimes within a particular geographical location, with the advantage of a lower premium. Out-of-network coverage applies only during medical emergencies. In-network coinsurance and cost sharing is similar to a PPO plan.
- Health Maintenance Organization (HMO)
This in-network design works by the selection of a Primary Care Physician who manages your healthcare needs, and can give referrals to allow out-patient procedures, access to specialists and testing. Though this plan has some of the lowest premiums, patients must be ready to bear potential additional costs of seeking out-of-network services.
Some HMO models allow access to in-network “one-stop-shopping” where a medical facility has just about any service from general care to physical therapy and prescription, which can be quite convenient.
- Preferred Provider Organization (PPO)
This plan offers maximum flexibility to choose your provider network and the care management system- both in-network and out-of-network. This referral-free model allows you access to dental specialists, diagnostic facilities, out-patient facilities, pharmacies and holistic providers, among others.
Although the patient has the freedom to choose the dentist care provider, some medical facilities may require pre-certification, to get approval from your insurance carrier. This ensures that you continue to enjoy your plan benefits in any medical facility, with the assurance that you are covered. This plan is however more expensive to purchase.
- Point of Service (POS)
A POS package contains the freedom of the PPO and the managed care aspect of the HMO. A primary care physician assesses your needs and either recommends in-network treatment or out-of-network referrals for specialized care.
- Discounted Fee-for-Service
Patients are entitled to a discounted price of dental care upon payment of full amount at the time of seeking medical-dental services. The advantage of this package is that the patients realize the full benefits on the spot, without any cause for further action; save for submitting any further paperwork such as a claim form.
- Dental Maintenance Organization (DMO)
DMO designs packages that provide lower cost dental services to members by directing them to a participating network of dentist. This network offers specific, predetermined services and charge discounted prices.
A dental PPO can be pricey, especially for patients seeking out-of-network services, as they will be required to pay for a greater portion of the cost. In this case, going for a Discounted Fee-for-Service model allows you to enjoy more service privileges within the network, with no limitations.
Consult your insurance provider to give you the Estimation of Benefits (EOBs) for every package to help you weigh your options.
Insurance companies often offer cover for dental benefits based on categories: Preventive- x-rays, medical exams and cleaning; Restorative-fillings, and Periodontics-deep cleaning and gum care among others. Claims spanning services not covered by the insurance company might mean additional out-of-pocket costs, so it’s often wise to consult before narrowing down your option.
Save more: Stay in-Network
It’s pretty obvious that you get to enjoy more benefits and lesser premiums within a network rather than out-of-network. Furthermore, in-network dentists pass on discounts as well as give referrals to other facilities allowing you a range of benefits. Waiting periods of certain services are also brief, compared to the latter.
Ensure that your dental care provider accepts PPO, DPPO and PDP dental insurances
This ensures that you do not incur additional costs of inconveniences of waiting on claims; while allowing you high-quality care to you and your family. Your dental care provider should also share a fully-detailed treatment plan on the impact to your health as well as the expenses involved.
Choose a family-based dental care provider
Family-based dental care not only ensures the best-personalized services but it also allows for easy follow-up. Family base care also has a flexible payment options, as opposed to the one-fits-all approach of ordinary covers, and can help cut down further on costs.
Consult your dentist for advice on the most affordable dental care packages that best suits your budget, while at the same time giving you exceptional service.