Now comes the core of the job — understanding what the patient's plan actually covers. Here's what you need to know about each coverage element.
Plan Types
DHMO
- Must use in-network providers
- No annual maximum
- Copayments instead of percentages
- Lower premiums
- Need PCP referral for specialists
DPPO Most Common
- Can use any provider
- In-network = higher benefits
- Annual deductible + maximum
- Percentage-based coverage
- No referrals needed
Indemnity
- See any dentist
- Reimburses % of "reasonable and customary"
- Most freedom, highest premiums
- Patient may have higher out-of-pocket
Benefits Breakdown
Most DPPO plans use a tiered benefit structure:
100%
Preventive
Exams, cleanings, X-rays
80%
Basic
Fillings, extractions, SRP
50%
Major
Crowns, bridges, implants
Key Insurance Terms
Terminology Flashcards
Click a card to flip it. Learn these terms — you'll use them every day.
Click to reveal
1 / 20