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1. Discount or referral dental plans aren’t associated with insurance whatsoever. They are specifically a dental plan and they differ from insurance options. The basis of these type plans is that they are contracted with certain dentists. The contract maintains that the dentist will discount regular fees in return for the plan provider supplying patient referrals. The patient is charged a small fee by the represented dental plan company and is also responsible for paying a reduced fee to the dentist which is often in the form of a co-payment.
2. Fifty to eighty percent of dental costs incurred are likely to be covered by traditional or indemnity dental insurance plans. Payment is received by the individual carrying the insurance on a traditional fee-for-service basis. Procedures such as preventive dental care may include that the insurance company make full payment. The amount of coverage varies per plan but is most often based on: Tables of Allowances type dental insurance or, Usual Customary, and Reasonable (UCR) dental insurance plans. These plans are often adjusted through deductible or maximum benefit allowances. VCRs are likely to base their payment calculation on the company’s usual, customary, or reasonable fee or the dentists’ fee whichever is less. The difficulty with these particular plans is that there is such a wide fluctuation and no certain regulations in determining fees are warranted.
3. Table of Allowances Plans use a list that provides the dental procedures covered by the plan. Each specific procedure has a dollar amount set acknowledging what amount the particular plan will pay. The patient is responsible for any potential balance.
4. Managed Care Dental Insurance Plans involve three sub-types: Capitation Dental Plans, Preferred Provider Organization dental plans, or Exclusive Provider Organization dental plans. Capitation or HMO insurance plans are an arrangement with the dentist to provide treatment for its specific members. The provider of treatment is usually paid a monthly fixed rate per dental plan participant. The dentist is required to provide treatment to these members within a specific time frame. Conditions vary per insurance plan.
5. A Preferred Provider Organization dental insurance plan develops a network of treatment providers similar to the idea of discount or referral plans. Utilizing dentists from this network will likely provide you with maximum benefits. Exclusive Provider Organization plans are similar to the “Preferred” plan. However, they don’t have the flexibility of the “Preferred” plan. You have to receive treatment through their network of providers.
