Most health
insurance plans in the U.S. are either managed by a healthcare
maintenance organization (HMO) or a preferred provider organization
(PPO). Many healthcare practitioners prefer PPO over HMO due to its
suitability in terms of coverage. As you know, dental insurance works
differently from other types of insurance since most, if not all, of
the dental problems can be prevented and treated with less cost. In
exchange for PPO insurance, however, the dentist now becomes a
“preferred provider.”
Consumers still have
the choice of whether or not to go to a preferred provider, but the
cost will be higher in a non-preferred provider. PPOs are also
simple; unlike HMOs, PPOs don't need any referrals, let alone a
primary care provider, for the plan to take effect. This translates
to more patients for a dentist as he can treat patients regardless of
referrals. With HMOs, however, patients need proof of referral before
the dentist can treat them.
In PPOs, preventive
dental care coverage ranges between 80 and 100 percent, basic care at
around 80 percent, and major dental work (e.g. implants, crowns) at
50 percent. For a regular check-up worth $50, the patient may only
need to pay no more than $10. The rest of the cost is shouldered by
the PPO. It's safe to say that patients who regularly practice proper
oral hygiene get to pay less for dental care.
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