How Dental Insurance Works

Dental Insurance can be acquired under a group plan offered by employers or can be purchased directly for an individual plan. Understanding the options and benefits available is important when making decisions about dental care and paying for treatment.

Can you list the different types of dental plans that insurance companies might offer?

Nina Vitale: Sure. There’s traditional insurance, there’s the PPO or the preferred provider organization, the DMO or the dental maintenance organization, and there are individual plans. The first three are most often parts of a benefit package offered by an employer. The individual plans are purchased by the consumer.

What is a PPO plan, and how does it work?

Nina Vitale: Well, a PPO plan is actually a three-way contract. The patient is offered a list of participating dentists by the insurer. If the patient visits a contracted dentist, then the dentist agrees to accept the fees outlined by the insurer, and the patient agrees to pay their deductible or any percentage of fee that is contractually ordered.

What is a DMO plan, and how does that work?

Nina Vitale: Well, the DMO is actually the most affordable plan, but it offers the patient the least amount of choice. In this plan, the primary dentist is named by the insurance company. In order to use the benefits provided, the patient must use this provider. Although the provider is able to give referrals, the referrals have to be to specialists who also participate in that particular DMO plan.

Does the dentist discuss and consider insurance coverage and out-of-pocket costs when treating patients and recommending procedures?

Nina Vitale: They should. At our office, patients are provided with the treatment plan after they’ve gone through a check-up. The treatment plan outlines the services that are recommended. The patients are then shown the financial cost to themselves, as well as what the insurance will pay. If it is necessary, we offer a financial arrangement. We can make arrangements for monthly in-house payments or we can provide the patient with CareCredit.

Will dentists offer discounted pricing for cash patients?

Nina Vitale: Well, every office has their own policy. Our office offers discounts for private-pay patients. These discounts usually range from 20 to 30% depending on the total cost of treatment. At our office, and in most offices, seniors are also offered discounts.

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