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New Year… New Insurance… Now What

New Year… New Insurance… Now What

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The following are questions that people call my office and ask my Insurance Coordinator every January. 

My new dental insurance from my employer is a DHMO; what is that? Does your office accept DHMO’s?

Dental Health Maintenance Organization (DHMO): When a dentist signs a contract with a DHMO insurance plan that provider agrees to accept an insurance fee schedule and give their customers a reduced cost for services as an In-Network provider. Many privately owned dental practices, including my office, do not accept these types of plans. 

My new dental insurance is a PPO. What does In-Network and Out-of-Network mean?

Participating Provider Network (PPO): We do accept PPO plans. By the very nature of this plan the insurance company generally pays the dentist a percentage of your services according to the policy you purchased. Depending on your specific plan, the PPO allows you to choose an In-Network or Out-of-Network provider. By choosing the In-Network option the provider and the insurance companies have an agreement to use a fee schedule that reflects the average fee in the area. With the Out-of-Network choice the insurance company and the provider do not have such an agreement therefore the insurance companies pay their percentage on the provider’s customary fee schedule. 

(Now you can see why the Insurance companies will try to persuade people to see In-Network providers. The few dollars saved on each procedure multiplied by the number of procedure procedures multiplied by the number of dentist multiplied by… well you see where I’m going with this. By seeing an In-Network provider you can save the insurance companies a lot of money. You? Not so much.)

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What if I have a dental plan that I have never heard of before?

You just may be in luck. Over the past years many insurance companies have been merging and buying into each other. This gives rise to a benefit that most people are unaware of. Your insurance plan may be accepted under a better known plan because of their affiliation. For example: My practice is In-Network with DHA/Assurant. If your PPO plan is Meritian Health (a plan that I have not heard of until the writing of this article) then you can come to my office as an In-Network DHA/Assurant participant and receive the benefits of that plan. 

But I don’t see you on my dental insurance website. Because these insurance company affiliations have created such a massive network of potential providers it would be a major undertaking to list all current providers on their website. This would require the Insurance companies to continually track the providers of all affiliate insurance companies. The best source of action would be to call my office to confirm if we would be an In-Network Provider

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