Finding a dentist can be a cumbersome process for anyone. For those who don’t understand how their insurance works from a coverage standpoint, it can lead one to avoid making the appointment altogether. When deciding what type of coverage works best for you and your family, there are many things to consider, from what type of procedures are covered to which dentist offices will accept your insurance.
HMO vs. PPO Plans
Many insurance companies offer two types of plans: a dental HMO (health maintenance organization) or a dental PPO (preferred provider organization). The HMO plans tend to be the least expensive, allowing patients to pay a predetermined copayment for covered services, but there are restrictions when choosing a dentist. These plans actually assign a dentist office, eliminating the convenience of having options.
Those with HMO plans can also expect less time with their dentist than those insured with a PPO plan. Dentists accepting HMO plans are typically reimbursed based on the volume of patients they see, potentially creating an incentive for your provider to rush through your cleaning or exam. Many patients insured under an HMO plan also express frustrations with the complex referral and claim process.
Choosing a Preferred Provider for Convenience
The more popular insurance option for individuals and families is a PPO plan. This plan allows you to visit any dentist you’d like to choose within the network. You can be more discerning and ensure your dentist offers the services you need and the conveniences you want. PPO plan holders are afforded the opportunity to find a new dentist for any reason, right down to the aesthetics of the office environment. This plan also allows you to choose a dentist outside of your preferred network, even though this will come with additional out-of-pocket expenses.
When you visit a PPO dentist, you pay a coinsurance, which is essentially a percentage of the cost of treatment. Certain services and procedures may be fully covered, while others could require you to pay a certain percentage of the cost. Typically, you pay a larger percentage for cosmetic and nonessential procedures.
Contact Us Today
Understanding your insurance coverage and its conveniences can be confusing for some. At the Center for Adult Dental Care, Dr. Kin Wong and our dedicated staff can help you make sense of what your financial commitment is regarding certain procedures. If you have questions about PPO insurance and live in the Burlington, Lexington, and Woburn communities, call us today!