Reaping the Rewards of PPO Insurance

Dentists constantly remind their patients to keep brushing and flossing daily to have stronger teeth and brighter smiles. However, as far as dental care costs are concerned, savings can be considered another reason. Preventive care under preferred provider organization (PPO) insurance may cost 80 percent lower at preferred dentists. In fact, some insurance companies may shoulder the checkup fully, which will surely be a heavy burden off the policyholder’s back.

PPO plans are among the fastest growing healthcare plans in the market today due in no small part to their simplicity. As dental care is predominantly preventive in nature, patients pay less for a preferred service provider. Dentists, on the other hand, receive most of the premium as reimbursement, tied to a specific fee schedule as per the agreement with the company. He simply needs to furnish proof that the policyholder indeed had his mouth checked at the dentist’s office.

Dentists are welcome to negotiate the fee schedule depending on the nature of their situation. Then again, the fact that more patients may go to a preferred dentist under a PPO plan can generate tons of direct profit. Under PPO, a patient can choose or not choose to go to a preferred dentist, but the cost of a non-preferred provider’s services will be substantially higher. More patients translates to more profit, so in the end, the dentist enjoys as many benefits as his patients.

A Good Reason to Raise Dental Fees

Any business on the brink of a deficit generally has two choices: cut costs or raise fees. As far as the cons are concerned, businesses are choosing between affecting quality and losing the trust of clients. That’s less of a concern for dentists, as a drop in quality service will, more or less, scare clients away. As the shepherds of teeth and gums, dentists can’t afford selling their state-of-the-art equipment to save on overhead costs.

 

They can try to cut costs on other areas, but most of the time they’ll need to raise their service fees to stabilize their finances. For any business, profit is the prize; after all, being unable to generate profit defeats the purpose of doing business. For years, dental fees haven’t been in sync with the rising costs of running a dental office. This places the dentist at the receiving end of negative revenue, which gets worse the longer it persists.

 

However, dentists must justify their reason for raising dental fees. Raising fees for the sole purpose of profit is less appealing to clients than raising fees for profit and keeping quality service alive. He’ll have to explain it to clients and insurance firms, convincing them that raising his dental fees will truly be for the best.

Helping Patients Save with Dental Reimbursement

Dental insurance is a great way to attract patients to your office. The cost of dental services can be kept to a minimum because the plan covers part of the cost depending on the nature of the service in question. To get a better picture of what dental insurance can do to patients, say your patient pays a visit to your office for his regular checkup. Normally, regular dental checkups fall under Class I, which is diagnostic and preventive care.

Most dental plans shoulder the cost of regular checkups at no expense to the in-network dentist. In fact, some dentists, thanks to full dental reimbursement, offer free dental checkups to also encourage people to take good care of their teeth. However, the effect of dental insurance is more apparent the more extensive the operation. In another example, say you have a patient scheduled for installation of bridges, which falls under Class III.

The typical coverage for Class III services is fifty-fifty; 50 percent for the plan and 50 percent for the dentist. As long as you honor the patient’s insurance policy, you can make the cost less of a burden for him. Out-of-network dentists have different and more expensive plans, typically a 40-60 split in which the patient shoulders 60 percent of the cost. Experts estimate that patients can save as much as $500 on major restorative care with an in-network dentist.

Getting the Ideal Dental Insurance for You

If you have gums that are red, swollen, and bleed easily when you eat or when you brush your teeth, it’s likely that you have a mild case of periodontal disease. Catching periodontal disease at an early stage is possible if you seek the necessary dental treatment right away. Doing so is easy if you have dental insurance to cover part of the costs of the dental services because you don’t have to worry whether you have enough cash or credit on your card.

A problem can arise if you don’t have dental insurance, so before things get worse, it’s smart to obtain it soon. However, not all dental plans offered under dental insurance are the same, and it’s critical to study all possible options first before you sign up with a company that provides that type of insurance. There are plans where major dental care procedures are covered, such as root canal, and there are plans that only cover diagnostic and preventive services.

Where you seek dental services is also an important part of the terms in dental insurance contracts. The insurance may only allow you to seek dental treatment from a preferred provider organization or PPOs, which means there is a specific list of dentists that accept the dental insurance. There is also the out-of-network option that allows you more flexibility to choose which dental facility to go to.

Negotiating to Raise Dental Fees

In this day and age most people are covered by all kinds of insurance to provide for all their needs. This includes cars, homes, various properties, health, retirement, and life insurance among many other things. It’s a practical and convenient way to ensure that you get the services you want when you need them most.

This program can be especially valuable in times of emergencies when you require immediate assistance. Without insurance coverage, it may be difficult to get the services you require from professionals that can address such needs. However, for medical health providers like dentists for example, such arrangements can be complicated and put them at a disadvantage.

This is especially critical for medical professionals who agree to be part of a group of health providers that render their services at a discount. It’s a great advantage to the public for the opportunity to use these services at a much lower cost. On the other hand, professionals like dentists may not be able to get what is rightfully due them.

Fortunately, there are companies that can help dentists negociate in raising dental fees to enable them to make reasonable profits. This requires savvy business acumen and medical practitioners like dentists need the help of these people to keep them afloat particular in times of economic distress, and that’s a valuable assistance that medical professionals need.

Don’t Go Overboard When Negotiating Fees

Dentistry is primarily a service, not a business, and so dentists should therefore value ethics more than making a profit. However, this reminder also goes both ways: a patient shouldn’t feel entitled to discounts or something just because he or she is a “regular customer” for example. A certain middle-ground can be seen only if a certain flexibility comes into play when discussing dental fees.

Much like any service provider, dentists vary in quality which means that if a patient isn’t satisfied with the services rendered, he or she has the right to negotiate the fee (within reason of course). Of course, it would help if the patient had researched the dentist before coming to his or her office. This is because dentists also work with dental labs (for creating dentures, veneers, etc.) which, in turn, vary in quality as well; knowing about the lab would give the patient an idea of what to expect from the dentist.

On the other hand, dentists also feel that it is their duty to serve their patients as best as possible since a bad treatment will definitely look bad on their record. However, even the best tooth procedure will be in vain if the patient doesn’t follow the dentist’s medical recommendations. In such a case, the patient is in the wrong if he or she still wants to negotiate the dental fees.

Knowing the Link Between Reimbursement and Dental Insurance:

While quite common throughout the world, tooth problems are such minor issues (compared to heart ailments and respiratory disorders) to some people that they think they don’t need to be insured for them. However, dental services can be so expensive these days that it is now wise to have health insurance policies that can cover a simple dental appointment. Dental policies have different classifications, conditions, and reimbursement rates.

The most popular of these are the HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans which both involve the patient having to subscribe to selected professionals, clinics, and facilities (a.k.a. a network) for medical care. These plans grant the patient a discount so long as he or she works with this network. However, penalties (such as additional costs) are given if the patient worked with a doctor or dentist who is “out-of-network”.

This is where reimbursement comes into play: some plans can cover a huge chunk (but not all) of out-of-network services while others simply can’t. Some dental plans can reimburse simple dental services (like teeth-cleaning, twice a year) or those done on the policyholder’s children. However, it is still strongly advised for policyholders to stick with the medical professionals and facilities indicated in their policy if they wish to get the best rates.

Exactly What Is Dental Insurance Reimbursement?

In these trying times, almost everyone wants to get insured. The growing insurance industry reflects the people’s need for security when unexpected misfortunes take place. Dental insurance is one of the most popular type of insurance purchased by virtually all employees working in private companies. Most companies include dental insurance in the primary health care benefits they give their employees.

 

Dental insurance comes in two forms: traditional plans and direct reimbursement. Traditional dental plans are known for their complexity, especially in the limitations surrounding the full benefits the employee is entitled to receive. On the other hand, direct reimbursement is simpler and easy to get. The employee has a clear view of what he’ll be receiving and may receive the benefit for more than one type of dental services.

 

It is more beneficial to purchase a direct reimbursement plan because of its flexibility. The only similarity it has with traditional dental plans is that it only pays for a certain amount of dental work each year. Usually, the fund ranges from $1,000 to $1,500 depending on which plan the client prefers.

 

A direct insurance reimbursement plan would pay for 100% of the first $100 of dental expenses. On the next, 80% would be covered, except there would be variation in the client’s choice. He may prefer to have the 80% of the next $1750 of dental expenses paid off or only that of the next $250 to still have a chance to get 50% reimbursement for future dental work.