An Introduction to Dental Insurance Plans, Terminology and Billing!

An Introduction to Dental Insurance Plans, Terminology and Billing!

Chris Comstock, who is an insurance guru is here to help us with an introduction to dental insurance plans, terminology and billing.   I call myself a dental insurance coach.  I enjoy insurance, what I really like to do is help people get the right plan, I’m helping people save a lot of money.  

Over the years I’ve learned all about dental insurance plans. Understanding insurances and becoming the premier expert on them is a goal of mine.  I find that understanding the insurances makes the patients happy, the doctors happier, and I can help people get the coverage they want.

 

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.

EPOs

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.

PPOs

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. There's not as many, there weren't as many for a while of those they were kind of making a comeback, it depends on where you are in the country, honestly.

You have to pay attention to your area too, as much as you and I can sit here and educate them, these insurances across the country are very specific to your part of the country.

Medicaid plans

Medicaid plans and ACA 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 either at healthcare. gov or through a licensed health insurance agent.

Summary

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.