Indemnity or Managed Care Plans?
Indemnity plans offer benefits but do not have contracts with providers because the provider has not elected to contract with the network or the plan is not affiliated with a network. These plans pay certain percentages from a “table of allowances” that provide a set dollar amount for each procedure. The patient is responsible for paying the provider’s fees while the benefits pay a portion of the UCR fees (Usual, Customary and Reasonable) or considered fees.
Managed Care plans offer benefits based on fees determined by the insurance company. Providers decide if they wish to participate in these plans so patients should ask if the doctor participates in a specific network before deciding whether or not to proceed with that provider. There are two types of managed care plans.
PPO or EPO (Preferred Provider Organizations or Exclusive Provider Organizations) offer a discounted rate for treatment provided to members of certain plans. Providers elect to contract with these plans. PPOs and EPOs are similar with the exception that EPOs do not allow patients to receive treatment by providers outside the dental insurance company’s network of providers. PPO patients may elect to choose a provider outside of the preferred network but they may receive a reduction in benefits.
HMO plans pay a regular fixed amount, usually monthly, for each patient in his roster regardless of whether the patient receives treatment. In turn, the provider renders needed treatment to the patient during a negotiated time frame. The patient is assigned to a particular provider for that treatment, during that designated time frame.
Estimated Coverage and Patient Responsibility
Filing insurance claims is a courtesy we extend to our patients. Our office staff will make every effort to help you understand your dental benefits plan, however, your insurance is ultimately your responsibility. Any estimate of any benefit that may be paid by the patient’s dental insurance company is purely an estimate and is never a guarantee of payment. Our office will submit insurance claim forms and credit any payments received. If the dental insurance company pays nothing, or pays less than what the patient anticipated, it becomes the patient’s responsibility to pay the balance owed. Patients’ co-insurance payments are due on the date service is provided. Non-covered procedures may be charged per the office fee schedule.