Dental Insurance Benefits 101

Insurance benefits can be so helpful and so frustrating at the same time. What is the difference between a PPO, EPO and HMO? What policy do I choose? What insurance plan does my doctor participate in? I will try to answer some of these concerns.

A PPO is a Preferred Provider Organization. The Doctor has chosen to be a part of that insurance company’s network fee schedule and agree to charge the patient based on the network fee schedule. The insurance company will encourage the patient to see the in network doctor but will also allow the patient to be seen by an out of network Doctor. If you choose to see an out of network doctor, the services rendered will be paid at the in network fee and the additional cost will be passed on to you. Sometimes it is necessary to be referred to a specialist who may be out of your insurance network.

An EPO is an Exclusive Provider Organization, the Doctor has chosen to be a part of that Insurance company in network provider, and the insurance company has a rule that the patient has to be seen by an in network Doctor in order to receive benefits. If you are referred to a specialist and do not see an in network provider, you will not receive any insurance benefit when services are rendered. It is important when choosing this type of policy that you are aware of this insurance rule.

A HMO is a Health Maintenance Organization. This type of insurance is a group based plan. Usually you can only see providers within its group of doctors. For example Kaiser Permanente or Willamette Dental are HMO dental offices. Our office does not participate in this type of insurance plan.

Dr. Willis is a Participating dentist with many insurance companies. If you are looking at a PPO or EPO policy, please give me a call at our Salem Oregon dental office. I am always available to discuss insurance. Insurance is forever changing and I strive to know what will work best for patient’s healthcare.

From Catherine’s desk – Insurance Coordinator