Annual benefits of dental insurance would have grown to over $7000 per year by now if they had reflected the average rate of inflation. This ultimately means the average dental patient does not receive the same amount of coverage he or she received in previous years.
There are generally two common types of dental insurance plans. They are traditional (or “indemnity”)
Patients may select any dentist they wish to perform their dental care with a traditional (indemnity) plan. Payments for these plans are provided on a “fee-for-service”
DMO’s (capitation plans) and PPO’s are the most common managed care plans. In these plans, benefits are usually limited if the patient chooses an “out of network” provider. The dentist is usually paid a fixed monthly amount for each patient on the plan regardless if the patient ever has any work done, in a DMO plan. DMO plans because of their low reimbursement tend to promote less than ideal dental care as the dental office has very low incentive to provide routine hygiene and preventative services.
A dentist participates in a PPO plan by signing a contract with an insurance company enabling him or her to attract patients who are covered by the plan. In order to receive the plans maximum benefits, covered plan members must select a dentist from the network of providers. However, if a patient is willing to pay higher deductibles and co-payments they are usually able to choose a dentist outside of their network.
Many employers are beginning to offer Direct Reimbursement plans because they allow an employee to choose any dentist they wish. With these plans, patients receive reimbursement directly from their employers for any dental procedures. The company manages these plans internally, allowing them to save a great deal of money.
Direct Reimbursement plans offer employees more options and control over their dental care choices, as well as lower internal costs for companies and less insurance headaches for patients and dental offices alike.
