When visiting a dentist in Riverside, California, and using your dental insurance, here are key things you should know and ask:
Verify Dental Coverage:
Is the dentist in-network or out-of-network for your insurance plan?
What specific dental treatments are covered (e.g. tooth extractions, dental crowns, root canals)?
Are there limitations on the number of cleanings or exams per year?
Understand Dental Procedure Costs:
What is your deductible, and has it been met for the year?
What are the co-pays or co-insurance costs for different procedures?
Are there any out-of-pocket maximums?
Preventive vs. Major Dental Services:
Are preventive services (cleanings, X-rays, exams) fully covered?
What percentage is covered for major services like dental bridges or dental implants?
Waiting Periods and Exclusions:
Are there any waiting periods for specific dental treatments?
Are there exclusions for pre-existing conditions or cosmetic procedures?
Claims and Billing:
Does the dentist file claims on your behalf, or do you need to handle it?
Are there options for payment plans if the treatment cost exceeds your coverage?
What’s the difference between PPO (Preferred Provider Organization) and DHMO (Dental Healtho Maintenance Organization) dental insurance plans?
The primary difference between PPO (Preferred Provider Organization) and DHMO (Dental Health Maintenance Organization) dental insurance plans lies in network flexibility, costs, and how you access dental care:
PPO (Preferred Provider Organization):
Network Flexibility: You can see any dentist, but costs are lower if you visit an in-network provider. Out-of-network visits are partially covered.
Specialist Access: No referral is needed to see specialists.
Cost Structure: Typically has a deductible and co-insurance. You pay a percentage of the service cost.
Premiums: Usually higher premiums but more choice and flexibility.
DHMO (Dental Health Maintenance Organization):
Network Restriction: You must visit in-network dentists; no coverage for out-of-network providers.
Primary Dentist Requirement: You typically have to choose a primary dentist who coordinates all your care.
Specialist Access: Referrals are required to see specialists.
Cost Structure: Generally, there are no deductibles, and you pay a fixed co-pay for each service.
Premiums: Lower premiums, but less flexibility.
| Feature | PPO | DEHMO |
|---|---|---|
| Flexibility | High | Low |
| Network Access | In-network & out-of-network | In-network only |
| Specialist Access | No referral needed | Referral required |
| Premium Costs | Higher | Lower |
| Co-pays | Percentage of service | Fixed amount per service |
| Deductibles | Yes | No |
