“Why can’t I just get a regular teeth cleaning?!!”
This question is one that I hear every day over my seven years that I personally have worked in an HMO dental office.
You see, an HMO dental office is one that accepts both types of dental insurance plans (PPO and HMO).
These types of plans differ greatly that I had to learn those differences almost immediately when I returned back to Corona, California, from a neighboring state, where HMO’s didn’t exists.
A PPO type dental plan is a Preferred Provider Organization
These plans have doctors who have signed contracts, agreeing to set fees for each dental service a dentist provides.
That means, if you go to a PPO contracted provider from your insurance company’s list of offices you receive these negotiated fees rather than their full fee (AKA UCR). Your average savings of about 20-30%.
An HMO dental plan is a Health Maintenance Organization
An HMO type of insurance gathers a list of patients from a group or employer and then assigns them to one dental office. They can only go to that one office unless the patient calls to change it. Then, the coverage is for the dental treatment that is medically necessary.
An HMO offers very low premiums for the employee, outlines 100% coverage on almost everything, and most with no calendar year limit of benefits. PPO plans usually have a $1000-$2000 limit per year.
The HMO representative promise $100 crowns, and free cleaning twice a year on everyone! As an example)…
And ….THIS IS WHERE THE MISUNDERSTANDING BEGINS!
The representative should not be promising prices on a dental service to a group of potential members because every mouth requires different dental care and maintenance. Every employee also has different dental history and oral conditions.
The simple comment “YOUR CLEANINGS AND CHECKUPS ARE TOTALLY COVERED AND NO COST TO YOU” is a widely used statement and only partially accurate. The exam and necessary x-rays are completely covered, but “cleanings” vary per patient.
The “cleaning” a person needs is a diagnosis of treatment to care for a person’s present oral condition. This diagnosis can only be given or dictated by a licensed provider or Dentist and not a receptionist, an assistant, an insurance representative nor anyone else.
If you are looking for a family-friendly and highly experienced dentist in Corona and have questions about your dental insurance coverage, feel free to call my dental office at (951) 273-0555 today to find out more information. We are conveniently located near East Ontario Avenue and State Street, just east of the 15 freeway.