HMO vs PPO Dental Plans? (tooth, implants, dentist, side)
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Hi. I'm new to dental insurance, so I'm not sure how it works. My employer gave me a form to fill out, and I need to choose between HMO and PPO dental plan:
Which one's better? Or does this entirely depends on every individual situation?
I live in Los Angeles, I've visited one dentist without insurance (I used Brighter), and I'm wondering which network would allow for cheaper service with that dentist? And in case that specific dentist isn't part of PPO/HMO, and only is part of Brighter insurance system, do I need to get anything from my previous dentist and get it over to the new one, such as dental x-rays which cost me a bit and I don't want to pay for them again?
Thanks guys! I'm clueless here, so I appreciate any assistance.
Hi. I'm new to dental insurance, so I'm not sure how it works. My employer gave me a form to fill out, and I need to choose between HMO and PPO dental plan:
Which one's better? Or does this entirely depends on every individual situation?
I live in Los Angeles, I've visited one dentist without insurance (I used Brighter), and I'm wondering which network would allow for cheaper service with that dentist? And in case that specific dentist isn't part of PPO/HMO, and only is part of Brighter insurance system, do I need to get anything from my previous dentist and get it over to the new one, such as dental x-rays which cost me a bit and I don't want to pay for them again?
Thanks guys! I'm clueless here, so I appreciate any assistance.
I think a PPO is generally better you have more options. With an HMO you are usually assigned a dental group and often stuck with them. Your best bet is to talk to someone in H.R. who can help you.
Do you want the cheapest at the expense of quality? Do you want an HMO crown or a PPO crown or a cash pay crown? People assume quality for some reason.
Read about the ethics of HMO plans. They pay a yearly amount to the dentist who has to do all your treatment for that amount of money. Therefore, there is a built-in incentive to do less work and undertreat, which can even result in neglect.
Lastly, these are not "insurance" plans. Insurance is something you hope you never need to use. Dental "insurance" is actually the opposite of insurance....they pay for small stuff like cleanings and xrays but not much for bigger stuff like implants and bridges. It would be like your auto insurance paying for your oil changes, but not for a major collision. This has to do with the entitlement mentality in our country where people balk at having to pay for a cleaning, while many women routinely pay the same amount for their hair. But they don't complain about their hair insurance not paying for some reason.....
I consider dental plans to be "discount plan memberships" that we can opt to pay for if we want.
My spouse and I have had some pretty extensive dental work done in the past few years, combined, so we've definitely benefited from our dental plan. We were "in-network" for most of it. And the guy who was not in network for my husband offered him a discount for some of the work that the plan would have covered if he was in network.
Do you want the cheapest at the expense of quality? Do you want an HMO crown or a PPO crown or a cash pay crown? People assume quality for some reason.
Read about the ethics of HMO plans. They pay a yearly amount to the dentist who has to do all your treatment for that amount of money. Therefore, there is a built-in incentive to do less work and undertreat, which can even result in neglect.
Lastly, these are not "insurance" plans. Insurance is something you hope you never need to use. Dental "insurance" is actually the opposite of insurance....they pay for small stuff like cleanings and xrays but not much for bigger stuff like implants and bridges. It would be like your auto insurance paying for your oil changes, but not for a major collision. This has to do with the entitlement mentality in our country where people balk at having to pay for a cleaning, while many women routinely pay the same amount for their hair. But they don't complain about their hair insurance not paying for some reason.....
.....then you end up spending most of your dental appointment in the "finance" section with the finance rep trying to talk you into financing procedures that may not be necessary.
My experience with DMO (HMO for dental) is here in Houston so yours may vary:
DMO got me the "bottom of the barrel" dentist offices like Southern Dental, Castle Dental, Lovett Dental, etc that see to welfare/medicaid patients mostly (probably because they receive up front $$ from the gov't)
Wait times are horrendous. When I finally got to be seen, the actual DENTIST spent about 3 minutes tops with me. The rest of the time i'm with a dental assistant.....or the finance guy.
In that 3 minutes with the DENTIST, I got a quick mouth exam, DENTIST looks at the xrays and says I need A, B, C and D (when in reality I only need A). I then got shuttled into the finance office, where they offered me Care Credit or some other form of dental financing to cover this work I all of a sudden so desperately need.
I've gotten crowns, they've popped out. I've gotten a front tooth chipped and they've fixed it 3 times, it breaks after a couple weeks. I've given up going back and just don't smile. I'm going with a PPO this year, as i'm over not getting good dental attention, and i'm sick of reading the accolades of other dentist offices on Yelp and not being able to take advantage of them because i'm stuck in the "welfare" line.
Maybe it's different in California, idk. If you choose it and don't like it, you're only stuck until next year when they have Open Enrollment again. Your experience may be different, I sure do hope so.
These are the two major dental discount plans available.
Firstly HMO: HMOs require some type of premium payment from patients for access to a network of dental care providers. In return for the premium, the HMO will cover the rest (or a portion of the rest) of the costs for your dental services. According to Dentalsave.com, to use a dentist outside of your HMO network, you'll have to pay the entire dental bill yourself.
While PPO: Like an HMO, patients covered by PPO plans must use the professionals that are part of the PPO network if they are to receive the full insurance benefits. Insurance providers offer referrals to dentists with whom they've pre-negotiated a rate. However, patients can also see dentists outside of the PPO network, but their insurance coverage won't be as comprehensive. They will also likely have to pay a bit more for dental services obtained outside of the network.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
