Insurance
How Dental Insurance Works
How PPO Dental Plans Work
A Preferred Provider Organization (PPO) is the most common form of dental insurance, offering members a network of participating dentists to choose from. Dentists in this network agree to lower fee schedules, resulting in greater cost savings for patients. PPO plans cover a percentage of treatment costs, typically paying 50% for major treatments like crowns and bridges, 80% for basic care like fillings, and up to 100% for preventative care such as exams and cleanings. These plans often have annual maximums ranging from $1,000 to $2,000 and assist with insurance billing.
Understanding your HMO
Health Maintenance Organization (HMO), also known as capitated or prepaid insurance, is a type of dental insurance plan that requires patients to choose a primary care dentist from a network of providers. This primary care dentist coordinates all aspects of the patient’s dental care and referrals to specialists within the HMO network. HMO plans typically have lower premiums and fixed copayments for covered services, but patients have limited choices in selecting dentists outside the network. Additionally, HMO plans may require patients to obtain pre-authorization for certain treatments, and coverage for out-of-network care is usually not provided except in emergencies.
Dental Insurance FAQs
Got questions? We have answers! Check out our FAQ section to learn everything you need to know about navigating dental insurance coverage.
Treatment that is recommended by a dentist, is listed on the fee schedule, and accepted under the terms of your group's plan.
Treatment that is either not listed on your fee schedule or more than the minimum to restore the tooth back to its original function.
Indemnity or Traditional Insurance reimburses members or dentists at the dentist's UCR (Usual, Customary & Reasonable fee). This allows the subscriber to go to any dental office without being limited.
