Every year or so employers may offer you the choice, when selecting your next dental plan, between a DMO and a PPO type plan. How will you decide? Do you have all the facts to select the right plan for yourself and your family? Who will give you all the facts – clearly stated and unbiased — as well as easy enough for a layperson to understand? The human resources personnel in your company might not even understand what your questions really imply. Can you get the answers you desire from the insurance companies themselves? Not a chance. Our experience over many years, dealing with insurances, shows us clearly that no patient … and absolutely no one… clearly understands the ideas behind how these convoluted insurances work out their plans. Where is the place and who is the person to turn to when you are in need of a complete spectrum of answers to your insurance dilemma? A possibility, of course, would be to discuss your choice with your trusted dental office. Will they have the answers? Will they be willing to spend precious time in educating you in this matter? Well, this all depends on several factors and particularly on your relationship to that office. The majority of insurance offices will already have many patients on the same plan in question and will be able to tell you what would be the best choice for you and your family. It also depends on your proposed treatment plan for the future and what aspect of the treatment plan can be financially maximized and optimized for you according to the plan you have selected. Some very simplified decision criteria will be touched upon here to enable you to examine your own dental situation and priorities regarding your options for the future. Remember, not all insurance years start on January 1. Some plans may not seamlessly cover your dental treatment in progress. If you are in the middle of an elaborate reconstructive dental treatment, switching the insurance company and/or plan will, in many cases, completely disrupt the flow of your treatment and in some unfortunate situations, negate part of the treatment plan which is already started. Some plans may have a waiting period for covering major dental work. Are you in a position to wait 6 to 12 months for treatment? Does your dentist urge you to take action A.S.A.P? If so, do not wait any longer; such plans with waiting periods are not for you. Simply put, if waiting for your new plan to cover your dental needs may jeopardize the life of the teeth in question, you may end up with an unnecessary root canal treatment which could have been easily avoided following the urgent advice of your dentist. Do all the plans incorporate a maximum coverage per year? As a patient utilizing a PPO, you must understand that no matter what your dental needs are, your PPO will never reimburse you or pay your dentist above and beyond the maximum amount stated in your policy. The majority of plans set this at a mere $ 1000 per year. More generous ones will add an additional $500. If you however, or someone in your family, has been diagnosed with major procedures, this coverage will barely scratch the surface of the costs. Such a PPO in principles, would only serve a patient on either a holding pattern with regard to treatment or needing only minor treatment such as fillings along with hygiene procedures. Would then DMO’s be better in these situations? No doubt they would. The DMO’s will provide the patient with a more reduced fee schedule, therefore you will save out of pocket expense and at the same time, by not restricting the dentist to an annual maximum, you may be able to afford larger and substantially more extensive treatments if necessary. As you can see the selection of a dental plan can be quite complex and therefore the best advice will always be to educate yourself in advance before choosing a plan and most of all, try to obtain the recommendations of your treating dental office. In our practice we are spending substantial time just with this kind of insurance education for our patients, in an effort to customize their decisions to the real need of their dental health. It is our goal to obtain, for our patients, the maximum coverage they deserve and therefore not only treat their dental conditions, but observe their financial needs; particularly in these uncertain times. Watch for our article in next month’s issue on preexisting conditions and the value of a second opinion.
© 2011 All Rights Reserved, Dr Florian Braich DDS PhD