Some doctors call it third party payee. Remember some doctors will not accept your insurance, and you are responsible for the billing and collecting the money. The good news, many doctors will accept your insurance and process the billing as a courtesy to their patients.
In the dental industry there are mainly three types of insurances:
Indemnity Insurance
Payment made by insurance to doctors honoring the UCR (usual, customary and reasonable) fees.
This kind of insurance have a yearly max from $ 1,000 to $ 2,500 and some might have up to $ 5,000 or more a year.
Remember they do not pay a 100% of the fees; they pay a percentage of the fees
From 100% to 50% of selected procedures
Patients will pay the difference plus a yearly deductible from $ 50 to $ 250 or more.
When you visit your doctor make sure you bring your benefit book and compare the doctor’s calculation to your benefits. Some dental offices might not have the details of your benefit which might delay treatment or you will get an estimate only for your out of pocket costs.
You can go to any provider you choose.
PPO (preferred provider)
Payment made by the PPO to doctors honoring a negotiated fee between the PPO and your doctor usually lower than the UCR fees.
The PPO has a yearly max from $ 1,000 to $ 2,500 and some might have up to $ 5,000 or more a year.
Remember they do not pay a 100% of the fees negotiated with your doctor; they pay a percentage of the fees from 100% to 50% of negotiated fees, and for selected procedures.
Patients will pay the difference plus a yearly deductible from $ 50 to $ 250 or more.
When you visit your doctor make sure you bring your benefit book and compare the doctor calculation to your benefits. Some dental offices might not have the details of your benefits which might delay treatment or you will get and estimate only for your out of pocket costs.
You must go to doctors on a list of participants.
HMO (Health Management Organization)
This insurance is based on HMO/ Doctors negotiated fees for out of pockets reduced cost per procedure.
No deductible, no yearly max.
You need to sign up for a particular office and the doctor there will be your primary care doctor, any specialty treatment needed your doctor must submit to the HMO and after approval you will be referred to a specialist for a reduced out of pocket treatment
You must sign up for a doctor from a list of participants.
Important point about utilizing insurance:
- Get a print out with your fees and out of pocket cost: make sure it matches you benefits
- Review the deductible and make sure to differentiate between individual and family yearly deductible
- Some doctors will do in house financing (no interest)for your deductible and out of pocket cost on the indemnity and PPO insurance, ask for it
- HMO patient: beware of upgrade, there is no upgrade in the dentistry, you need an ideal treatment, not upgraded treatment, your HMO might have benefits for regular treatment on some procedures, but the ideal treatment might cost you more.
- Very few Indemnity insurance, PPO’s or HMO’s covers dental implants , cosmetics crowns and some complicated procedures, as a patients using the insurance in that office many dentists will give you a courtesy discount on those procedures, ask for it
- All insurances are good in an office where they are a customer service oriented offices, if they complain about your insurance, leave, you don’t deserve that as a patient.