Dental Insurance: What are the Differences between HMO and PPO Plans?

Dental Insurance: What are the Differences between HMO and PPO Plans?

By Mina Levi, DDS, 05/21/2015

One of the most common questions we get asked here at the office of dentist Mina Levi, DDS in San Francisco is “what is the difference between choosing an HMO dental plan and a PPO dental plan?” along with “are you an in-network provider?” Many people who have dental insurance or are in the market for dental insurance have concerns and/or are confused about different plan aspects and sometimes can end up locked in with a plan that isn’t a good fit for them. Dentist San Francisco Mina Levi, DDS clears up some of the dental insurance lingo and answers some questions in this week’s article.

What is an annual maximum?

Most dental insurance plans limit the amount that they will pay out for services per year. The average annual maximum in our experience is around $1500. This means that after that annual maximum has been paid out for the year, any services rendered after that will be an out-of-pocket expense for the patient until the new year comes and the annual maximum rolls back over.

What is an in-network provider?

Dental insurance companies have contracts with certain dentists in your area. This means that the dentist has agreed to see patients who have this insurance plan and only charge the fees for services as lined out in the contract. This means that when you see an in-network provider with your insurance, the services you receive will be charged at a “discounted” in-network rate. So even when you are maxed out of your dental insurance yearly maximum and all services are out-of-pocket, all services will be at this same discounted rate.

What is an HMO plan?

HMO stands for Health Maintenance Organization and this kind of plan limits subscribers to choosing a dental care provider that is an in-network provider only. The patient must choose or is assigned a pre-approved dentist and if the patient seeks treatment elsewhere, the dental bills will not be covered at all.

                Pros: More affordable

                Cons: No freedom of choice, limited access to dental providers

What is a PPO plan?

PPO stands for Preferred Provider Organization and offers flexibility for subscribers when choosing dental providers. A PPO dental plan will allow the patient to choose an in-network provider or an out-of-network provider, but will pay more or a higher percentage for an in-network provider.

                Pros: Freedom of choice, wider range of providers

                Cons: More expensive

If you have more questions about dental insurance, PPO plans or HMO plans, visit Dentist San Francisco Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Dentist San Francisco, dental insurance, insurance, insurance plans, dental insurance plans, dental PPO, dental HMO, HMO plan, HMO insurance plan, PPO, PPO insurance plan, dental PPO, PPO plan

Can I Use my Medical Insurance for Snoring and Sleep Apnea Appliances?

Can I use my Medical Insurance for Snoring and Sleep Apnea Appliances

By Mina Levi, DDS, 12/23/2014

If you suffer from sleep apnea or you snore at night, your Dentist San Francisco may recommend that you have an appliance custom-made for you, as untreated sleep apnea and snoring can lead to a number of issues. However, many patients are concerned with the relatively high cost of sleep apnea and snoring appliances and have questions about how they can have their dental or medical insurance cover the cost of the appliance. In this week’s article, San Francisco Dentist Mina Levi, DDS discusses medical insurance billing for sleep apnea and snoring appliances.

First, check dental:

If you are being seen by a dentist and the dentist is going to be fabricating the device for you, the first thing that you should check is your dental insurance coverage of the specific appliance code that the dental office gives you. For example, an occlusal guard has the code D9940, and some plans cover these types of mouth guards at 50% of the insurance company’s contracted rate. When speaking with your dental insurance company, you should ask three things:

1) What is the contracted rate for this procedure code?

2) Is this procedure code a covered benefit on my plan?

3) What is the coverage percentage rate?

Next, check medical:

Many medical policies offer coverage for oral appliances. Check with your dentist to see if they will be billing to your medical policy or if you will be needing to submit your own claim. If you are submitting your own claim, there are some things you will need to gather from the dentist:

1) A copy of the medical claim form (latest revision as of April 2014)

2) Exam notes and patient history (including symptoms, past treatments, exam findings, and treatment plan)

3) Radiographs such as an FMX or panoramic x-ray, or if those are not available then 4 Bitewings may be sufficient

4) The medical code for the appliance (this will be different from the dental code)

5) Letter/narrative of medical necessity

Another treatment that is also covered by most medical insurance companies is a sleep study, in which physicians monitor your sleeping patterns and diagnose your sleep apnea. The records from the sleep study can be sent in to the insurance company to ensure coverage of a sleep apnea appliance.

If you have questions regarding sleep apnea and related appliances, visit Dentist San Francisco Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Dentist San Francisco, sleep apnea, sleep apnea symptoms, sleep apnea appliance, snoring, snore guard, snoring appliance, medical insurance, dental insurance, dental claim, medical claim, medical coverage, dental coverage, medical coverage oral appliance, dental coverage oral appliance, medical coverage sleep apnea appliance, dental coverage sleep apnea appliance, dental coverage occlusal guard, occlusal guard

Affordable Dental Care: Tips to Follow When Choosing Dental Insurance

Affordable Dental Care: Tips to Follow When Choosing Dental Insurance

By Mina Levi, DDS, 03/27/2014

Dental insurance can assist you in taking good care of your oral health by covering some, if not all of the financial portion of care.  When choosing a the dental insurance plan that is right for you, you will want to consider quite a few things other than what it will cost you to obtain it. Sometimes, the most affordable dental insurance isn’t the best fit for you. In this article, we discuss a few points that you will want to consider when choosing a dental plan. 

1. The ability to choose your own dentist. Some dental insurance plans will restrict you so that you may only receive care from a dentist that is contracted with that plan or so-called an “in-network dentist”. You are more than welcome to go to an “out-of-network” dentist, but they will not be paying for any of it. If your preferred dentist is not in-network with the most affordable dental care plan, you can either switch dentists or choose a plan that includes your dentist.

2. The ability to schedule appointments. Some dentists that are in-network will limit scheduling times to certain dental insurance participants, so it is important that you make sure that the dental insurance you choose is not limited on your dentist’s schedule.

3. The ability to choose the best treatment. Quite a few dental insurance plans will restrict payment for services to the cheapest treatment for a condition. For example, if your dentist recommends a composite (tooth-colored) filling for a cavity, your insurance may only pay the amount that is allowed for a lower-quality amalgam (metal) filling, so you will pay more out-of-pocket. There may be other treatment choices available that your dental insurance plan will cover a higher percentage of, however, we recommend proceeding with the treatment plan that is most highly recommended by your dentist.

4. The coverage itself. Most high quality dental insurance plans will cover about two professional cleanings and exams per year with no cost to you, which usually includes digital x-rays and fluoride treatment if needed. The cost of other procedures such as fillings orcrowns are usually paid by insurance plans between 50-80% of the total cost up to the annual maximum payout, leaving you with an out-of-pocket expense. The better quality the plan, the more that will be covered. However, if the affordability of the insurance plan is an issue, there are other smaller plans that are good that have slightly lower percentages of coverage.

If you have concerns about what dental insurance plan is right for you, give premier dentist Mina Levi DDS a call at (415) 513-5066.

Topics: affordable dentistry, affordable dental insurance, dental insurance, dental insurance plans, in-network dentist, contracted dentist, affordable dental plans, out of pocket expenses, dental fees, dental appointments, oral health, professional cleanings and exams, digital x-rays, dental coverage, dental procedures, dental deductibles