Traditional Dental Insurance

The traditional dental insurance encompasses the treatments performed by dentists. A patient can then submit the claim to the insurer for bagging benefits associated with the insurance policy as promised by the insurance company.

Dental Insurance for Managed Care

Particular dental procedure and specific dental treatment techniques are associated with dental insurance for managed care. The managed care program is offered in an attempt to cut costs on dental treatment services being catered to insured patients. All sorts of health maintenance organizations (HMO's) and preferred organizations (PPO's) come in this form of dental insurance.

Insurance Terms Patients and Dentists Need to be Aware of

All-important terms of the dental insurance plans have been discussed in detail in the following text; however, doctors and patients must be aware of the following norms associated with dental insurance:

Traditional Dental Plans (Indemnity Policies)

The traditional dental insurance plans that are backed by the indemnity policy cover every treatment session and associated dental care that they receive from their dentists. Fee for every dental service is included in this insurance plan. Here are the key points of the indemnity policy a dentist must know:
• What sort of benefits are associated in the dental insurance plan and to which dental procedure
• Benefits may vary from one dental service to others. In the case of preventive dental care, the benefits might be 100% of the treatment cost
• For various other types of dental procedures, the benefits provided might be just 50% to 80% of the treatment cost
• In a case where only the partial cost of the dental procedure/treatment is covered, the remaining cost is borne by the patient
• The benefits associated with the other dental insurance plans must be given a read before providing patient with dental procedures

The level of benefits provided depends on the procedure's classification.

Indemnity plans generally employ an "open panel" of dentists where patients seeking dental services are bestowed with the freedom to get the treatment procedures from the dentists of his preferred choice. The total amount of benefits associated with the policy is limited by a deductible sum that has a certain maximum limit on a yearly basis.

How Benefits Are Calculated

Insurance benefits are provided on the basis of the following two schemes:
1. UCR plans, i.e., "usual, customary, and reasonable"
2. "Table of allowances" integrated into the plan
Dental service providers must look into the benefits associated with the insurance plan or the allowances and coverage that a customer is promised in the plan.

Managed Care Dental Insurance Plans

A dentist must be aware of the principal dental insurance plans to plan his dental procedures on patients in the view of their dental insurance plans. Insurance companies offer dental insurance to customers as backing to dental care costs. Here are the three principal dental insurance organization plans that a dentist can associate himself in the club of insurance-bound dental services:
1. Capitation Dental Plans provided by Dental Health Maintenance Organizations (HMO)
2. Dental insurance plan offered through the Preferred Provider Organization ("PPO")
3. Dental Insurance program offered through Exclusive Provider Organization ("EPO")

Dental Health Maintenance Organization (Capitation Dental Plans)

The dental insurance plan, which is also known as the Capitation plans, is comprised of an arrangement as set by Dental Health Maintenance Organizations (Dental HMOs). The organization, i.e., HMO is actually a network of dentists, dental offices, and other sorts of players in the dental services. A patient pays a fixed sum every month to his preferred dentist that he chooses from HMO. It then becomes a dentist’s obligation to provide patients with the needful dental care or any other dental services that are specified in the insurance plan for the agreed time period.

Preferred Provider Organization (PPO) Programs

These are kinds of insurance plans where medical service providers such as health/ dental care facilities and doctors/dentists are brought in a network. Those (patients), who register themselves in the network are insured to get dental care from doctors, hospitals, and other healthcare professionals at a minimal price. Other healthcare services that don’t fall in the network can also be brought to aid at an additional price.

Exclusive Provider Organization (EPO) Plans

Insurance plan catered to the clients through Exclusive Provider Organization (EPO) makes use of doctors and hospitals within its own network to provide patients with the health/dental care services. It’s, in general, like a Health Maintenance Organization (HMO) plan. Unlike the PPO plan, it doesn’t allow patients to get treatment form anyone outside the network. This is also worth noting that no out-of-network benefits are associated with the EPO insurance plans.

How a Dentist Can Wisely Make Choice of Organization to Associate with from HMO, PPO, and EPO

A dentist can make his own choice of organizations that he wants to be associated with from the HMO, PPO, and EPO as discussed above. An HMO can be as small as only a single dental office or as big as thousands of dental care facilities. If you are looking forward to being part of a dental insurance-bound club/organization from the three as discussed above, you must evaluate your benefits besides the benefits associated with patients seeking treatment or dental services through your organizations’ insurance plan.

An Insight into ‘HMO’ – Decide If It’s Worth Your While.

HMO’s (Dental Health Maintenance Organization) dental insurance offering is said to be strictly bound in a "closed panel" as the dentists’ community in the club is not permitted to offer patients with the out-of-organization treatment procedures. A dentist seeking an alliance with HMO must evaluate his benefits from patients’ insurance plans and what sort of treatment procedures he is permitted to practice.

HMO Philosophy and Procedure

Contrasting to fee-for-service (indemnity) insurance plan where a patient pays to the dentist for each and every dental procedure, a dentist is paid a predefined sum by patients irrespective of the actual cost of a dental treatment procedure. Here, it will be wise for dentists (who wish to be in the club of HMO) to keep their patients’ oral health in good shape to save on revenue. As a matter of fact, the more treatment procedures a dentist performs, the more money he loses.
The formula and philosophy for an HMO dentist to save on health care procedures are simple and straight – serve less to save more. If a patient’s oral health rightly remains in order, he will need not much oral treatment procedures from a dentist. Consequently, it will help dental care professionals to save more on dental care procedures that he is meant to offer to patients ailing with oral disorders.

Get Enrolled to only a Reputable HMO Plan

If you're looking forward to joining an HMO, it would be wise to do a bit of research beforehand to get an insight into its reputation and benefits it holds for dentists. Better get an eyeful of the frequency of dental appointments, range of treatment options available, and the size of patients community it serves. This way, you can take the measure of the HMO and its plans if they are really worth your while.

Preferred Provider Organization (PPO) Insurance Plans – What It Holds for a Dentist

Similar to HMOs, Dental PPO's are regarded to be serving the community with dental procedures in an arrangement of ‘closed panel’. Here in the PPOs, a set of insurance companies brings dentists under a contract with dental care professionals to create a flourished network of dental service providers and dental care facilities for patients. You as a dentist, if you wish to be associated with the PPO club, you will be required to provide patients with discounted dental care services.

Some PPOs serves in an ‘Open Panel’ Arrangement

PPOs are kind of closed panels where dentists are hardly permitted to serve out of the group. However, there is flexibility in place only if a dentist is ready to cut on his benefits that he is privileged to receive as PPO member. If you are willing to be part of the PPOs, you must take every term in the account before coming up with the final decision.

Some PPO's Have Even a Larger Network of Dentists and Patients

By integrating the network sharing agreement in the course of dental treatment and insurance procedure, the PPOs have turned to be an even bigger community. Here one PPO agrees to work in mutual coordination with other PPOs making the organizational setup/community of patients and dental care professionals. This, as a point of view, makes the Preferred Provider Organizations bigger and better bringing more benefits for the dentists in the club.

Exclusive Provider Organization ("EPO") Dental Insurance Plans

Exclusive Provider Organizations (EPOs) are also kind of "closed panel" dental insurance that is similar to PPOs in nature. The only difference is that the EPOs are strictly bound in closed arrangem4ents, i.e., they don’t allow patients to receive dental treatment procedures for other dentists except for the member of an organization’s network.

Selection of Dentist in the EPO Plan

This is of great significance to know for a dentist how a dentist is selected in the Exclusive Provider Organizations (EPOs). A dentist can continue his dental services to existent patients in the EPO plan, however, if a new patient is seeking any sort of dental services from the organization, he is free to choose his dentist through closed or open panel.

Open Panels

In ‘Open Panels’, any dentist can take part in the organization process as a dental service provider for the participating patients. Since the freedom is in place offering dentists the flexibility of participating in the dental procedures, it is said to be as ‘Open Panel’. This, in fact, provides patients with the freedom to make a choice for their preferred dentist.

Closed Panels

There are some programs where dentists, who are not the registered members of the EPO organizations, are not allowed to commence dental procedures on the insured patients. With obligations in place, the panel is known to be the closed panel. The open panel has been designed to provide patients with benefits to get dental procedures from their favorite doctors, while the closed panel offers the benefits to the member dentists only.
Both the closed and open panels have their own virtues and shortcomings for dentists and patients. You can select the organization with the open or closed panel in the view of your intent and purpose.