Dental Insurance-Related FAQ’s

Dental Insurance FAQ's - Confusing

September 30, 2021

Dental insurance has a lot of complexities and our amazing from office team does a great job of weeding through it all to give you the greatest benefit. Being that we are an office that receives and works with many different insurance types, we also get a lot of questions regarding insurance coverage. Below are a few FAQ’s about dental insurance that.

What do you mean by “Preferred Provider?”

Preferred Provider - Son on Dad's shouldersFirst of all, the phrase “Preferred Provider” is only relevant to those who carry dental insurance. If we are a “Preferred Provider” under your insurance, we’ve simply made an agreement with your insurance company to provide for your dental care needs at the rates that are aligned with their contractual fees.

When you sign up for dental insurance, you have the option to select dental plans that are PPO, which stands for Preferred Provider Organization. A PPO dental plan is insurance that lets you work with Preferred Provider dentists who will care for your dental needs for subsidized out-of-pocket costs.

When you receive your dental insurance card, it will usually designate “PPO” as your dental plan. Your insurance company should provide to you access to a list of dental care providers that are under their network of Preferred Providers. You can always ask our team if we are a Preferred Provider with your dental insurance company also. Regardless of whether or not we are a Preferred Provider with your insurance company, our dental team can serve you–your out-of-pocket costs may vary simply because we are not under a contractual agreement with your insurance company.

Feel free to call us to verify whether or not we are a PPO provider for your dental insurance or to see how we can help: Our Kirkland Office (425) 739-9093; Our Seattle Office (206) 464-9002.

How Does The Complexities of Dental Insurance Affects My Bill?

Unfortunately, dental insurance is just one of the many, very complicated systems within our insurance world. Dental plans vary significantly and change constantly, which for the patient means the amount you pay whether through monthly premium installments or copays can also vary significantly. Although our staff strives to give our patients the most accurate estimate of a copay amount for their appointment, once the dust settles between us and your insurance company, the resulting copay amount may vary from the initial estimate that was given. Unfortunately, our due diligence is not the ultimate verdict when we are dealing with your insurance company.

Your out-of-pocket costs will vary based on a number of labels you will see when searching for the right dental plan: Participating Provider, Preferred Provider, Members Choice, PPO/DPPO, HMO/DHMO, in-network, out-of-network, HBO and the like—totally kidding with the HBO; needless to say, this complicated list of labels is important for you to navigate when you are budgeting for your dental care needs. Here are my layman definitions for the following dental labels:

Participating Provider/Preferred Provider/Members Choice: All refer to an agreement made with your insurance company to provide for your dental care needs at discounted rates intended to save you money.

In-network: If we are “in-network,” our dentists are part of the agreement made with your insurance company to provide for your dental care needs at the rates that are aligned with their contractual fees.

Out-of-network: If we are “out-of-network,” our dentists are NOT a part of any agreement with your insurance company, and so your out-of-pocket costs may vary because we are not under any contractual agreement with your insurance company.

PPO (Preferred Provider Organization)/DPPO (Dental Preferred Provider Organization): You may see these terms used interchangeably. PPO/DPPO dental insurance plans allow you to gain care from in-network providers for subsidized out-of-pocket costs, but allow you the flexibility to receive care from out-of-network dental providers if you so choose.

HMO (Health Maintenance Organization)/DHMO (Dental Health Maintenance Organization): You may see these terms used interchangeably. HMO/DHMO dental insurance plans allow you to receive care from in-network providers for subsidized out-of-pocket costs. The in-network primary dentist that you choose determines whether your dental care needs should be referred to a specialist or not. If your primary care dentist does refer you to a specialist, your insurance plan will likely cover the costs.

Make sure you check with your dental insurance companies PPO and HMO plans for their comprehensive terms and conditions offered. As always, feel free to call us to help you navigate what label we may fall under with your insurance or to see how we can help: Our Kirkland Office (425) 739-9093; Our Seattle Office (206) 464-9002.

What Some Differences Between HMO and PPO?

Difference in PPO vs HMO - Two difference ShoesHere’s a general overview of the differences between a PPO and HMO dental insurance plan:

PPO if you want . . .

  • More flexibility to choose providers without needing a referral first.
  • Pay as-you-need services.
  • Lower out-of-pocket costs.

HMO if you . . .

  • Do not need to have the flexibility of choosing providers.
  • Want a prepaid plan by knowing how much you’re going to spend on services.
  • Do not want to deal with paying a deductible.

Dental Benefits from Your Employer

We believe that it is a blessing to receive any type of dental benefit from your employer. When you submit your dental plan to our team, we will do everything possible to maximize the dental benefits provided by your employer. If you are unhappy with your employer’s dental plan as a result of your out-of-pocket expense, please remind yourself that we are not the one’s providing you with this insurance. We will be steadfast with our due diligence in making sure that your employer’s dental benefits for you are maximized.  

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