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And now I will tell you about the third kind of dental insurance in more detail…

III. PPO (Professional Provider Organization)

This type of insurance takes a place between the compensatory kind (Indemnity insurance) and HMO (for more information you can explore the post Dental Indemnity Insurance). Group of the dentists, which refers to so called “preferred providers”, render the services with big discounts, allowing you to save on the treatment while you remain in their network of scope. However, as against HMO plan, you can receive some discounts, even if you are out from this network. Many dentists do not encourage this PPO plan since the low payment for the work limits their ability to provide services of the high quality.

Features of the plan:
1) a monthly insurance payment;
2) an annual limit of the amount of compensation;
3) you can choose a dentist from the offered list only, otherwise - a high nonrecoverable pledge;
4) average expenses $20 a month;
5) the companies selling this plan, submit to State Department of insurance.

<:3 )~~~~~~
Yours sincerely,
AlexSandra

So, let’s consider the second kind of dental insurance in more detail…

II. Direct reimbursement

A new form of services payment which has appeared as alternative of HMO and the traditional kind of insurance (for more information you can explore the post Dental Indemnity Insurance). It is the self-financed plan according to which the employer pays the certain percent from the sum for dental treatment of the worker from the special fund. The insurance company (”middleman”) is actually switched off from the process, that is why the administrative expenses were decreased. The worker visits a dentist, pays for his/her work and receives the receipt for the given services. Then he brings this receipt to the employer, and receives compensation of his expenses from the dental fund of the company. The employer chooses the percent of payments which he can compensate to you, and the annual maximum of the plan.

Features of the plan:
1) there is no preliminary payment, lists, exceptions, monitoring of procedures performance, etc.;
2) low payments (on the average, 30%-75 % is lower, than in other plans);
3) a choice of a dentist at own will;
4) fast assignment of your reception.

There are two kinds of payment: compensatory and payment for the purpose. When the worker choose compensatory payment he settle the account, the check will be sent in the Department Direct Reimbursement (DDR) - the compensatory check will be sent to the worker back - the worker pays services of the dentist or uses indemnification to compensate the previous check.

When we speak about the payment for the purpose we mean that the worker settle the account - the check will be sent in DDR - the compensatory check will be sent to the dentist - the worker pays residual balance only.

The majority of employers choose the compensatory kind of payment. The advantages of this desidion are the following: the average expenses are lower, than in the second kind since only the worker is responsible for the settling the account.

<:3 )~~~~~~
Yours sincerely,
AlexSandra

Let’s consider each kind of dental insurance in more detail…

I would like to tell you about the following plans:
I. Dental Indemnity insurance
II. Direct reimbursement
III. PPO (Professional Provider Organization)
IV. HMO (Health Maintenance Organization)
V. Dental discount plans

So, the first kind of dental insurance….

I. Dental Indemnity insurance

It is the traditional plan of insurance in which you pay for service (fee-for-service). The insurance company pays the certain percent for so-called UCR - usual, customary and reasonable (service). These payments are based on the average prices. There is commonly encountered situation: the insurance covers 100 % of your expenses for preventive maintenance of dental diseases (medical examination, cleaning of teeth and X-ray photography), 80 % of expenses for the basic treatment (simple tooth stopping, extraction of a tooth), and 50 % of expenses for the specialized treatment (root canal treatment, crown of tooth, bridges, other kinds of prosthetics).

Thus, the patient pays nothing for preventive maintenance; 20 % from the sum for the basic treatment pay, and pays 50 % of the specialized treatment. Usually there is a limit of the sum which the insurance company is ready to pay a year.

For example: from January, 1 till December, 31 the insurance company has established a limit of the sum - $1000. If the patient exceeds this figure, let it be $1200. In this case these $200 he pays from his own pocket since under the contract the insurance is not distributed to the sums above $1000. Therefore, it will be quite reasonable to make some treatment in one calendar year, and the rest - to transfer to the next.

Features of the plan:

1) High, not compensated, initial investments ($20-50). Usually well developed plans do not apply not compensated payments to preventive services;
2) Annual limit of the amount of compensation;
3) An opportunity to choice the dentist at own will;
4) Average expenses $19-50 a month;
5) The companies selling this plan, submit to State Department of insurance.

<:3 )~~~~~~
Yours sincerely,
AlexSandra

Do I actually need the dental insurance?

Many of us asked this question. While you are young and healthy, have no problems with your teeth, and visit the doctor 2 times a year for preventive maintenance you will refuse dental insurance since cost of the insurance can be much greater cost of your treatment. However, if you not absolutely healthy person and have not the most pleasant impressions from visiting dentists, certainly, it will be favorable to you to get such insurance. Even despite of water fluorination in the USA, annually millions of Americans require this or that dental health treatment. There is a set of the factors influencing health of our teeth: the hygiene, consumed food, stress, personal habits, etc. Even in perfect conditions, sooner or later, the majority of people would face expenses of dental treatment.

There are two basic kinds of dental insurance which allow patients:
A) To choose the dentist at own will (open panel);
B) To choose the dentist from the given list (closed panel).

To the first group includes:
1) dental indemnity insurance;
2) direct reimbursement.

The second group includes:
1) the professional organization giving services (PPO - professional provider organization), and its “version” EPO (Exclusive Provider Organization);
2) the organization of public health services (HMO - health maintenance organization);
3) the insurance based on the reduced cost of treatment (dental discount plans).

<:3 )~~~~~~
Yours sincerely,
AlexSandra