Indemnity Plan: Allows you to select your own dentist and go to any office you choose. These plans usually pay most or all of your Preventative and Diagnostic services, with a small co-insurance percentage for minor restorative, and a larger co-insurance percentage for major services. Indemnity, like most plans, will carry an annual maximum benefit. This plan allows you and your provider the most freedom of choice.
Preferred Provider Organization (PPO): PPO dental plans operate like an Indemnity plan, but the Insurance company will tell our office what we are allowed to charge you for services, and will claim that if you visit “in-network” dentists you will have a lower out-of-pocket cost. However, we have seen that with many PPO’s, there is no difference in your out-of-pocket cost. We participate in the vast majority of dental PPO’s. Even if we don’t participate in yours, your benefits may still work perfectly in our office. Each plan is different, as are the needs of each patient. Our office personalizes our service to you by calling your insurance as a courtesy to you, and honestly informing you if we are in-network or not, whether your plan will work well in our office, or if your out-of-pocket costs would truly be lower if you went elsewhere. This is rare, but we will tell you if it is the case.
Discount Plan: Discount plans “rent” you access to PPO network dentists in return for you paying a premium to them each year. If we participate in one of the PPO networks (such as Aetna or Dental Benefit Providers), and you purchase a dental discount plan in that network, you would pay a “discounted” fee at the time you receive service. The fees are “usually” lower than Usual and Customary Rates (but not always!). As always, we recommend researching thoroughly what your options are and if this will actually save you any money, once you take their premiums into account.
Direct Reimbursement Plan: Some employers have a plan in which they directly reimburse employees for dental services they receive.
Capitation Plan (also called Dental HMO or “DMO” plans): Capitation dental plans designate specific dentists for treatment. You will have to select one dentist that you will see for treatment, and he/she will decided if or when he/she will refer you for specialty care (such as a root canal or extraction). There are forms and can be lengthy pre-determination times for services, even if you are in pain. These DMO dentists have a contract indicating that they will be paid a monthly fee for having you signed up in their office, regardless of whether dental treatment was provided to you! It is to their financial benefit to collect their monthly capitation check while minimizing the amount of time they spend seeing you in their office. Then, even when services should be “covered 100%”, your DMO dentist can add costly “upgrade” fees to your services, and you may end up with higher out-of-pocket costs than with a traditional insurance plan. Many patients find, as well, that they cannot get an appointment for routine services such as a “100% covered” cleaning or exam for weeks or months. These are a few reasons why we do not participate in capitation or DMO plans.