Dental Insurance

When shopping at local markets, stores offered you many options; sometimes choosing the items you need is simple, however at times it is really hard. When shopping for life insurance, the options are not that simple; health insurance plans vary widely between one company and another. When selecting your health insurance, you should know for whom your plan is designed; coverage will vary if the plan is for an individual, family or group. In the case of Dental Insurance plans, in the United States they are usually divide into 3 groups:

  1. Indemnity Dental Insurance Plan
  2. Dental Health Managed Organization (HMO)
  3. Participating Provider Network (PPO)

Indemnity Dental Insurance Plan

A dental plan that has several benefits, this type of coverage provides patients the opportunity to stay with their dentist and she/he is not obligated to participate in a dental network. This insurance plan makes each procedure subject to coverage as it is needed and performed. Additional benefits of this dental plan include:

  • Preventive dental care, could be covered by 100%
  • Basic or Major dental procedures could be cover by 50%-75% (% cover will vary, check with representative)

The additional treatment costs that are not cover, the patient will have to pay the difference. Overall, this plan offers patients “open panel” dentist. Meaning you can select your dentist, have your dental treatments covered and be satisfied with the results.

Dental Health Managed Organization (HMO)

This dental plan offers you different benefits, compare to an Indemnity Insurance Plan. In this insurance plan, your dentist signs a contract with an insurance company; after the contract is set, both the provider and dentist agrees and accept on an insurance fee. Also, the provider accepts the commitment to offer their clients a reduced cost for service as an: In-Network Provider.

Dental HMO insurance plans have little to no waiting periods and cover most major dental works. When patients purchase this plan; the patient is trying to prevent annual fees and defray the high cost dental of dental procedures. In summary, this dental plan offers you:

  • The Dentist is paid a fixed amount on a schedule time
  • The Dentist is obligated to provide services and all needed treatments to their patients.
  • The insurance provider makes a contract with the dentist.

HMO plans are “closed panel” plans; unlike “open panels” in a closed panel you usually only have a single dental office or clinic. As mention in this insurance plan, the dentist is paid for each and every procedure they perform; based on contract agreements.

Participating Provider Network (PPO)

Dental PPO works similar to dental HMO, PPO are also an In-Network Provider; but unlike HMO this dental plan allows you to use an Out-of-Network or Non-Participating Providers. In this insurance plan, the providers make a contract with dentists or dental clinics; both basic and major procedures are usually fully covered and when negotiations are being made an annual maximum benefit is set. Each year the annual maximum is re-issued; however if the beneficiary reaches their annual maximum any additional treatment become the patient’s responsibility.

An exclusive deal that this insurance plan offers you is that they are both “closed and open panel”. This means you have the following benefits:

  • The insurance company makes a contract with a dentist or dental clinics.
  • You are allowed to choose your own dentist or clinic
  • Most treatments and procedures are fully covered, due to an annual maximum benefit
  • The contract makes the dentist agree to discount their patients fees

When selecting an Insurance plan, you must be careful; keep in mind that it is your health what could be in stake. Not knowing all the details can make you loss some benefits and affect your oral health.

Please keep in mind these 3 steps:

  1. Know the basics: know your health needs and what provider(s) can prevent and take care of the problem.
  2. Understand and know the cost: each plan will cover different percentages of procedures and will have different costs.
  3. Find your plan: coverage can/will vary per state (even if it is the same company); when looking at the Market, ask questions and obtain as much information as possible.

Sani Dental Group is located in Los Algodones, Mexico; we accept most dental insurance providers and are committed to meeting your satisfaction. Check with your representative or with us to determine the best plan you and your family needs. For any additional information contact us; we will use all of our resources to assist you, restore your smile and satisfied all your oral needs.

Disclaimer: All content shown in this blog and in any linked materials are not intended and should not be construed as medical advice. Any recommendations are based on personal, not professional, opinion only. If the reader or any other person has a medical concern about their dental care and treatments, please contact us directly. For more information please read our Disclaimers and FAQ pages.