Dental insurance can be confusing, but it can also be very helpful in making dental care affordable for patients. A majority of patients get their dental insurance through their employer while others purchase their own standalone insurance.
In short, patients with dental insurance pay a certain amount each month to their insurance provider and this allows them to get free or discounted dental services. Dental insurance plans are highly variable. Most plans cover preventive care at 100%, including teeth cleanings, exams & x-rays. After that, basic care & major procedures are covered at different percentages.
There are many types of insurance plans available and knowing what PPO, HMO, or Fee-for-Service means will help you make an informed decision when choosing your in-network or out-of-network dentist. Remember that according to the type of insurance you have, your coverage and benefits will vary in different ways.
Many people get confused about what it means for a dental office to be in-network or out-of-network with their dental insurance provider. While “out of network” sounds like the office wouldn’t take your insurance, that’s not always the case and it depends on the type of insurance plan you have.
HMO vs PPO Plans
HMO plans are Health Managed Organization plans. HMOs provide coverage that is limited to those dentists that are IN-NETWORK.
This means that with an HMO plan, you have a designated provider who has established a contract with the insurance company to provide dental services at a pre-established rate. This way the insurance company can set lower premiums for affordable dental care. However, with an HMO plan, you will only be able to see in-network dentists.
PPO or Preferred Provider Organization plans also offer dental coverage to insurers at reduced rates but PPO plans are much more flexible and the distinction between in-network and out-of-network is much less limiting. A PPO plan allows you to choose any provider working in-network or an out-of-network dentist if you wish.
By choosing an in-network dentist, you will receive dental care at pre-established rates that the dentist has agreed to with the insurance company, but you’re limited to the providers on the list. By choosing an out-of-network dentist, you are free to choose the one that best suits your needs but you may spend more out of pocket because the provider is not subject to any fixed prices.
Both in-network and out-of-network dentists can work with insurance. As previously mentioned, out-of-network does not mean you can’t use your insurance. It doesn’t mean you won’t get any benefits from your plan either. Choosing an out-of-network provider means you will have to pay for services at the time of treatment.
At Marilyn M. Machusick, DDS, Inc….
While we are in network with several insurance companies, as a service to our patients, our practice will file claims electronically to your insurance company regardless of being in or out of network. We will answer any questions you may have about your insurance and will do our best to maximize your insurance benefits so you pay as little as possible for your care.
In order to make dental care financially available to all of our patients, we have several payment options available to you. Prior to beginning treatment, we will discuss fees and financial arrangements with you.
Dental Benefits Assistance
We are considered an in-network provider for Delta Dental Premier, Assurant PPO, Aetna PPO, United Concordia PPO, Guardian, Unum and Sun Financial. Our practice will bill any insurance company used by major employers in our area. Please contact our office for insurance related questions.
Our fees are based on the quality of the materials we use and our knowledge in performing your needed treatment. Our goal is not to let expense prevent you from benefiting from the quality of care you rightfully deserve. To facilitate this we have the following financial options:
Major credit cards such as Visa, MasterCard and Discover are all accepted in our office.
We offer dental financing through CareCredit℠.