What are covered benefits?
Covered benefits are dental services that are covered by the premium of your insurance policy. If you don’t know what services your insurance covers you may call your insurance provider or us to find out. Covered benefits are also referred to as covered services.
What is considered an optional treatment?
Optional treatments are treatments that are either not listed in your fee schedule or the cost of your procedure is more than the allowance for your dental plan. Some insurance companies will make allowances for specific procedures on a case to case basis.
What are the 3 main categories for dental insurance?
Insurance Providers typically break down services into 3 main categories: Preventative, Basic, and Major. Most insurance companies cover these categories as followed:
- Preventative (typically covers 100% for PPO)
- Sealants that prevent decay
- Basic (typically covers 80% for PPO)
- Fixing Chipper Teeth
- Simple Extractions
- Periodontal Treatment
- Major (typically covers 50% for PPO)
- Surgical Extractions
What is the difference between Indeminty, PPO, and HMO Insurance Plans?
Indemnity or Traditional Insurance allows the subscriber to visit any dental office without having to choose from a list of providers. The insurance then reimburses the dental office for any treatment provided to its subscriber based on a UCR (Usual, Customary, and Reasonable) fee schedule.
Preferred Provider Organizations (PPO) is the most common form of dental insurance. This plan provides its members with a list of dentists in their area to choose from. The dentists have agreed to a fixed fee schedule agreement with the insurance company, usually at a deeply discounted rate, giving the patient substantial savings.
Health Maintenance Organizations (HMO) are referred to as capitation plans or prepaid insurance. They are designed to provide the most basic dental treatment to the subscriber at the lowest rate. Fee’s for the treatment rendered are usually greatly reduced, but the patient is typically responsible for most of the cost. Usually dentists are paid on a per person basis rather than the actual treatment that is provided by the dentist. Thus, the patient is responsible for the fee’s.
Do you have Dental HMO / DHMO / DMO insurance?
While we are not a dental HMO/DMO/DHMO provider clinic, please note that on some major dental procedures such as extractions (including wisdom teeth and full-mouth extractions), root canals (endodontic treatment), dental implants, dentures our fee structure is frequently lower that it is for the contracted dental HMO/DHMO/DHMO dental specialists.
Treatment compensation to our offices for services performed on Friday afternoons, late evenings and weekends. You will have to contact your dental HMO / DHMO / DMO insurance provider to obtain an authorization to be seen our office. Please call us at (916) 520-1717 should you have any questions.