How to Help your Patients Choose Dental Insurance

By: Shir’re Harris, Account Manager at  eAssist, FAADOM

Have you ever heard “what Insurance should I choose”, during Open Enrollment Season? If you have been in the industry for more than a year, you have heard this a time or two!  Most dentist are providers for one or more dental plans. Take the time to inform your patients of the plans that you accept. Also be sure to educate them on the different elements to consider while selecting their plan, this will be an added bonus to your practice as well as your patients. It isn’t recommended that you select a plan for your patients; however, it’s beneficial to make them aware of dental insurance facts.

Dental Plan Patient Education   

DPPO (Dental Preferred Provider Organization) Patients can receive care from an in-network or out-of-network provider. Providers can be changed at any time during the coverage period. Generally under a DPPO, patients have a yearly deductible with an annual maximum paid out per individual. This may also include a copay based on the service. A summary of benefits is provided. If there is a need for treatment that isn’t listed it is generally an indication that the specific service will not be covered by the insurance plan. The patient is then responsible for paying at the provider rate.

DHMO (Dental Health Maintenance Organization) Patients are assigned or must select a provider from a specific list identified by the insurance company. Patients must appear on the Providers roster before they can be seen. This plan typically does not include a yearly deductible, waiting period or yearly maximums, and may include copay. A summary of benefits is provided. If there is a need for treatment that isn’t listed it is generally an indication that the specific service will not be covered by the insurance plan. The patient is then responsible for paying at the provider rate.

DSP (Dental Savings Plan) Patients receive a discounted rate based on the plan they select from participating providers. This is not an insurance plan. Once the annual membership fee is met, participants will receive a card that states their coverage period. The membership must be renewed yearly to receive the discounted rate. Patients pay the Provider at the time of service. There are no insurance claims and generally no waiting period for services to be performed.

Key points to review with Patients

1.       Is there any outstanding treatment and what will their plan cover?
2.       What is the yearly coverage maximum?
3.       What deductible and/or copayments is the patient responsible for?
4.       Is there a waiting period and, if so, for which services?
5.       Does the plan have a missing tooth clause?
6.       Does the plan have downgrades on treatment?
7.       Is there a maximum payout per tooth?
8.       Are they saving or paying more money out-of-pocket based on their premium, the treatment they need and services actually covered (schedule of benefits)?
9.       What is their provider choice, and will the relationship be with their provider?
10.   Will their plans coordinate if they have more than one dental plan?

We have daily changes in society and these changes continuously affect our health care coverage. Dentists have the responsibility to practice dentistry, share knowledge, understanding and the importance of good oral health care with their patients. As members of a dental staff, it is important that available dental plan information is shared to ensure that patients are making the right choice for their individual situation.

eAssist Helpful News and Billing Tips; Edition #104