Local Dental Care - Aetna Dental Access Network

What Type of Dental Plans Have the Best Benefits?

Dental PPO, POS, DHMO Or Fee For Service

Indemnity and managed care dental plans differ in their basic approach. Put broadly, the major differences concern choice of providers, affordable out-of-pocket costs for covered services, and how bills are paid.

Usually, an indemnity dental plan offers more choice of dentists than managed care plans. An indemnity dental plan pays their share of the costs of a service only after they receive a bill.

Managed care plans have agreements with certain dentists to give a range of services to plan members a family at an affordable cost.

In general, you will have less paperwork and lower out-of-pocket costs if you select a managed care-type plan and a broader choice of dentists if you select an indemnity-type plan.

Managed dental plans include Dental PPOs, POSs, and Dental HMOs (DHMOs).

What is a Dental PPO, POS, and DHMO?

A Dental PPO (Preferred Provider Organization) provides dental care to its members through a network of dentists who offer discounted fees to its affordable dental plan members. You can typically use dentists out of the PPO's network, but you will only be reimbursed the discounted fee for the services rendered - you will need to pay any additional amount yourself.

A DHMO (Dental Health Maintenance Organization) provides you dental services through a network of providers in exchange for some form of prepayment. If you use a dentist out of the established network of providers, you may be responsible for paying the entire bill.

A Dental POS (Point of Service) plan allows a member to use either a DHMO network dentist or to seek care from a dentist not in the HMO network. Members choose in-network care or out-of-network care at the time they make their dental appointment and usually incur higher out-of-pocket costs for out-of-network care.

What is an Indemnity Dental Plan?

An indemnity dental plan is commonly known as a fee for service or traditional plan. If you select an Indemnity plan you have the freedom to visit any dentist. You do not need referrals or authorizations; however, some plans may require you to pre-certify for certain procedures.

Most indemnity plans require you to pay a deductible. After you have paid your deductible, indemnity policies typically pay a percentage of "usual and customary" charges for covered services; often the insurance company pays 80% and you pay 20%. Most plans have an annual out of pocket maximum and once you've reached this they will pay 100% of all "usual and customary" charges for covered services.

Many dental indemnity plans also require a waiting period before covering certain services.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Dental Insurance: Maximize Your Dental Health

What do you want from your relationship with your dentist? Oftentimes, this question is answered when there is a dental problem or emergency requiring immediate attention. There is a different approach to your relationship with your dentist that relates to your own needs and the dental plan you have. This approach is designed to help you create the kind of experiences you want with your dentist.

You have a choice about this relationship and how it can support and assist you in your life. It begins with the simple question stated at the beginning of this article: What do you want from your relationship with your dentist? Are you just looking for a doctor who can take your dental plan? Or, do you want more?

The answer to this question can take many forms. For some people it may mean having a lot of information about their dental health and future. They seek facts to know they are making good, informed decisions. Others may want a friendly relationship in which openness and communication are valued.

They want information your dental plan, but more importantly, they want to know they are important to the dentist and the dental team. Some individuals want minimal information and discussion -- just the facts and the solutions to take care of any problem.

We all have different wants in our relationships with health professionals such as dentists. Here are five tips to assist you in deciding what you want in your relationship with your dentist:

• Do you want a lot of detailed information about actual problems or potential problems or do you prefer a quick summary of data with recommendations about what to do with you dental plan.
• Do you like to make quick decisions or do you prefer to think about things before you act?
• Do you like to talk about what is happening or do you prefer to have your dentist just tell you what is going on?
• Do you want the dentist to describe a problem situation and solution with pictures so you can see what it happening or do you prefer to go on gut feeling?
• Do you want to maximize your individual dental plan?

Each person looks for different things in their relationships. It is your responsibility to determine what you want and look for that in the relationship with your dentist. The answers to the questions above will tell you something about this.

The next step is communicating what you want so that you are understood. Only you know when someone else understands you. Here are four tips to assist you in this communication process:

• Tell your dentist that you have some ideas about how he or she can assist you with your dental insurance plan.
• Ask when it would be a good time to discuss your needs and desires for your dental care and relationship with your dentist.
• Communicate what you want and how that will help you.
• If you had a negative experience in the past with another dental professional, always discuss what happened. Past hurts or disappointments have a way of negatively influencing present situations that are similar in nature.

Communicating what you want is important to your dentist for it is the best way for him or her to maximize your dental plan for you.

By Brian DesRoches, PhD

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.