An Introduction to Dental Insurance Plans, Terminology and Billing!

An Introduction to Dental Insurance Plans, Terminology and Billing!

Health Insurance Guy Chris Comstock here and I'm going to give you an Introduction to dental insurance plans, terminology, and billing.  Does getting a root canal sounds easier than understanding the difference between EPO, PPO, and Dental maintenance organization on your dental insurance?   No need for a root canal lets get to understanding more about your dental insurance choices...

An Introduction to Dental Insurance Plans, Terminology, and Billing!

People should have someone that understands all the different types of insurance.  Dental insurance plans have changed immensely in the last five or six years.  It's gotten much more difficult for people to understand all of what's coming at them.  EPOs PPOs HMOs, It's all very confusing.


We'll start with EPOs many people have never heard that term and it is a hybrid between an HMO where you're assigned to an office and a PPO where you can go to any office and they'll pay a certain rate. This is forcing you to go to an office that's an EPO and part of it you can't go out of network

They won't pay anything because we're considered out of network and as I say. The difference between EPO over the phone and PPO over the phone is not so much.  So, do you take Delta, well, we're par with Delta.


The PPO s are up there too this is a preferred provider or preferred dental provider network. Basically, these are plans that dentists sign a contract and agree to a certain set of fees and that they won't charge the patient above those.  On a PPO plan, you can go to any office and they'll pay a certain rate.  

Dental Maintenance Organizations

Dental maintenance organizations which is the dental version of an HMO. You're assigned to an office, that office is typically getting a capitation check every month and there are smaller co-pays.  There might be smaller out-of-pocket depending on the plan.

You have to pay attention to your area too, as much as you read online, these insurances across the country are very specific to your part of the country.

Medicaid and ACA plans

Medicaid plans and ACA (affordable care act) plans are ones that you have to follow the rules or you can't collect.  ACA dental plans, which stands for the Affordable Care Act.  A lot of people just stayed away from it and now the Affordable Care Act plans are a little bit more flexible. Some of them have PPOs, but these are the plans that people purchase on their own through the marketplace or at healthcare. gov or through a licensed health insurance agent.


With a little bit of knowledge, you can get a plan that meets your needs and be sure you get the most benefits out of your coverage.  I always recommend a PPO plan.  They're the most predictable and the most widely accepted by dentists.