Dental insurance is a complicated topic not only because of how it works in general but also because there are many different kinds of dental insurance plans available. Understanding the differences between these plans is the only way that you can be best prepared to assist patients with their coverage and billing needs, especially since every patient is different, and will have a different plan according to the factors specific to their lives. We’ll break this down in the easiest way possible. It’s a great idea to take notes as you go through this module. While it might be especially hard to grasp concepts such as those related to insurance, writing down key terms and information in your own words in a short and memorable manner will make a huge difference in how quickly you are able to grasp the information.
Different Types of Dental Insurance
There are also a few other types of dental insurance that do not fit into the categories above. For example, discount dental plans are not traditional insurance plans, but offer discounted fees for dental services from participating providers. These plans usually have an annual fee, and in exchange, patients will pay a discounted fee for each service they receive rather than receiving full or complete coverage.
Direct reimbursement plans are offered by employers as an alternative to traditional insurance. This plan means that the employer reimburses employees for a portion of their dental expenses, up to a predetermined limit.
Exclusive provider organization plans (EPOs) are similar to PPO plans, as they also have a network of dentists who offer discounted rates. However, there is no coverage for out-of-network care, so patients will have to stick to in-network dentists in order to receive their benefits.
While every dental practice is different, and the insurance that they accept will be determined by the demographics of their patient base as well as their location, there are a handful of prominent dental insurance providers that you might already be familiar with. The majority of the most popular insurance providers supply both indemnity and managed care plans, such as Delta, MetLife, Cigna, United Healthcare, and Aetna.
In-Network Dentists vs. Out-of-Network Dentists
In-network dentists have a contract with a specific dental insurance provider to provide dental services to their policyholders at a discounted rate. This means that the dentist has agreed to accept the insurance provider’s payment as payment in full for the services that they provide.
Out-of-network dentists do not have a contract with the insurance provider and are therefore not obligated to provide services at a discounted rate. This means that the patient may be responsible for paying the difference between the dentist’s fee and the amount that the insurance provider is willing to cover.
Whether or not your practice is in-network or out-of-network depends entirely on the insurance plan that an individual patient uses. This means that it’s essential to understand how to navigate both of these different scenarios.