Dental Insurances some information
Dealing with dental insurances has been one of the most frustrating things to do during my 34 years of being a dentist. When I first started there were not near as many insurances that offered dental coverage. To say life as a dentist was a lot easier before dental insurance is an understatement. Dentist didn't have to worry about billing insurances, wondering what they are going to pay for, how much they are going to pay and if they are going to pay. They didn't have to explain to patients what their insurances cover and don't cover and why they didn't pay for a treatment.
There are so many dental insurances now that it is hard to keep track of them all. And then, some insurances are underwriters of other insurances so the patient might be listed in more that one insurance that they don't know of.
There are 2 basic types of dental insurances, like medical insurances there is the HMO plan and PPO plan and there use to be an indemnity plan which paid what we charged.
HMO plans have "in network" doctors you have to see for treatment if you want the insurances to pay for it. You can go to out of network doctors but HMO plans will not cover treatment unless maybe it is an emergency.
PPO plans also have a list of dentists which is much broader and you can go to any that take that PPO plan. PPO plans have better coverage for treatment but still don't pay for everything and rarely pay 100% of the treatment. Usually they pay for 50% to 80% depending on the procedure. Some pay for 100% for dental cleanings but have a yearly deductible. Many pay 50% for dental fillings and crowns and bridges and often pay 80% for root canals. Many are still not paying for dental implants but will pay for the crown that goes on the implant.
HMO plans don't pay for everything either and when they do you have more out of pocket to pay especially when they don't cover a procedure. They pay the dentist a lot less than PPO insurances. They might pay $50 for a larger filling and $300 for a crown so
the dentist would want to do a crown instead.
My office does not accept HMO insurances or I don't belong to any of the plans.
Why ? Because the reimbursement for procedures is way to low for the type of dentistry I do. Also there are many procedures the pay nothing for ( "0" ) and don't even cover my expenses. Many don't pay or pay say $25 for a regular cleaning which take my hygienist an hour to complete. I pay my hygienist between $40-$50/hr which is average in California. For everything else I would break even unless I saw 2-3 times as many patients a day compared to the number of patients I see that have PPO insurances.
PPO insurances pay more because they cost more to the patient. For being part of the PPO insurance plan we have to accept the PPO insurances list of accepted benefits, meaning they tell us what they are willing to pay for whether the patient needs it or not. And, they all have a fee schedule we have to accept so they are telling us how much we can charge the patient and nothing more. These plans pay at a rate starting at about 20% below our UCR fees which are our usual and customary fees we would charge to patients without any insurance. Most people have insurance that go to the dentist but not all. At the office Daniel Huigens DDS we try to give people that don't have dental insurance a discount comparable to what the fees are for a good PPO insurance. Dentists that take HMO insurances have to make up the low fee reimburse by some means such as seeing many more patients a day, spending less time with each patient and charging whatever they can to decease their loss of profit.
I see many patients with HMO insurances paying almost as much out of pocket as they would if they had a PPO insurance.
So when thinking about what type of dental insurance I should get I would recommend a PPO plan which there are a ton of and it depends on what is offered by your employer if they offer insurance. I would like to see employers have their own policy whereby they reimburse their employee a certain amount for each dental treatment. The boss can make his own list of benefits for the employees. An advantage of this is that the employer doesn't have to pay for dental insurance for people that don't even use it. The employer can save a lot of money this way. We call this type of plan , "direct reimbursement" .