We are often asked this question on the phone from residents all over the Tri-Cities. The answer is pretty simple… we take ALL of them!
Insurance can be confusing – from the type of insurance to what is covered by it; it can be especially daunting to pick out a new insurance plan that is best for your situation. If you are in the market for doing so, we are here to help break down the 3 most common types of health insurance plans by abbreviation: PPO, POS, and DHMO.
A Preferred Provider Organization, or PPO, results in a lower out-of-pocket cost for the member when utilizing an in-network provider. The dentist is bound by contract to charge a reduced fee; this results in a lower out-of-pocket investment for the patient. In addition, some PPO plans offer higher coinsurance (the percentage at which a claim is paid). For example, a PPO plan might pay claims at 100/80/50% — the 100/80/50 coverage means that the insurance company will pay 100% of the cost of routine preventive care, such as checkups or cleanings, 80% of fillings, root canals, and other basic procedures, and 50% of major procedures, such as crowns or bridges. This is all dependent on if the dentist is in-network. Out-of-network providers might get the same claim paid at 90/60/0%.
Point of service plans, or POS, are discount plans. The patient pays a reduced fee for the service, which varies greatly by the plan. These plans are not traditional insurance; no claims are mailed to the insurance company to be paid. The patient pays a discounted rate at the time of service, typically about 20% less than the regular price. Similar to a PPO, you may receive care from out-of-network providers, but with greater out-of-pocket costs. You may also be responsible for co-payments, coinsurance, and an annual deductible. POS plans also require a referral from the doctor in order to see a specialist.
A Dental Health Maintenance Organization, or DHMO, is similar to many medical plans. There are no deductibles or maximums, and the patient pays a simple designated co-payment for the treatment provided. For example, a crown co-payment might be $175; this is considerably reduced from both the PPO or the POS plans. Diagnostic and preventive treatments often have no co-payment; however, if you visit a dentist out-of-network, you may be responsible for the entire bill. You do need to have an assigned primary care provider for all treatment, and a referral is usually necessary to see a designated specialist. A DHMO can be a very affordable option for individuals and families.
At Creekside Dental, we are passionate about our profession, and believe everyone should have access to great dentistry at an affordable price. For this reason, we accept all of these options, as well as others not listed here. For patients without any type of dental coverage, we offer substantial discounts.
If you have questions, we would love to assist you! Two members of our wonderful team have considerable expertise with any insurance-related matter. Our Insurance Specialist has over 25 years of dental experience, and our Financial Coordinator has 20. They help patients understand their benefits, obtain pre-authorizations, and provide financing solutions. The bottom line is: we want to make YOU smile!
Creekside Dental Front Office
Paola, Sheree, Melissa, Deb