Buying into a dental practice means one day being a care provider as well as a business owner. Running a business comes with its own set of perks, but also comes with an entirely different set of management tasks. Now, you’ll find yourself with those two major responsibilities on your plate, and it’s up to you to drive your practice to a successful future.
During this time, you’re sure to come across patients with varying degrees of dental coverages, benefits, and plans. It’s important to understand what each coverage means for you, and what you and the patient each bring to the table. Getting a better understanding of these coverages now will prepare you for any patient that comes into your future practice.
Courtesy of a previous THE NEXTDDS webinar presented by Ms. Evelyn Ireland, Executive Director of the National Association of Dental Plans (NADP), here are six dental coverages you need to know, and what each coverage entails:
Discount Dental Plan
Also known as a "dental savings plan", this is not an actual insurance plan. Here a panel of dentists agrees to perform services for enrollees at a specified discounted price, or discount their usual charge. No payment is made by the Discount Dental Plan to the dentists, who are instead paid the negotiated fee by the enrollee.
Dental Health Maintenance Organization
With a DHMO, comprehensive benefits are provided to a defined population of enrollees paying for general dentistry services from a contracted network of dentists. This includes point-of-service dental HMOs that provide an enrollee the opportunity to opt-out of the HMO provider network and obtain dental services on a fee-for-service basis.
Dental Preferred Provider Organization
A DPPO contracts with dentists for the expressed purpose of obtaining a discount from their typical fees. Discounts may be negotiated on a provider practice basis or through use of a schedule of fees. Enrollees receive value from these discounts when using contracted providers. They do not include participating provider agreements based on a fee-for-service.
Providers are reimbursed on a fee-for-service basis and there are no discounted provider contract arrangements, whereby the provider agrees to accept a fee below his or her customary fee.
Dental Exclusive Provider Organization
A DEPO will limit coverage to in-network providers or facilities. Patients may select where they access and receive care, and copayments and deductibles are similar to those found in PPO plans. There is no out-of-network coverage; the insured is fully responsible for costs of care delivered by an out-of-network provider.
Patient pays the bill, turns in proof of payment, and gets reimbursed; alternately the benefits' payment may be directly assigned to the dental office. Benefits are stated as a maximum dollar limit per year per eligible individual, or a percentage thereof. Reimbursement is based on dollar expenditures rather than on the type of treatment received.
Different plans have different implications for reimbursement and payment of your services. As a new dentist, it will be your mission to keep track of what each coverage means for you, your practice, and how you treat the patient. Stay prepared as you begin your journey to leadership in your own practice. For a deeper review of dental insurance coverages and dental care terms, download a helpful glossary of terms that Ms. Ireland provided THE NEXTDDS to share with you!