Learn About Dental Insurance

Dental Insurance can be complicated, but it is is not as difficult as navigating regular health insurance plans. We will simplify the types of dental insurances and explain them in simple terms below. 

Types of Dental Insurance

There are four types of dental insurance available. They are :

  • Indemnity – Self funded and allows you to see the dentist of your choice without any restrictions.
  • Preferred Provider Organization (P.P.O.) – P.P.O is an arrangement between the insurance company and the dentist, whereby the dentist agrees to lower his fees to meet a prescribed fee schedule administered by the dental insurance company and sold to your employer for a reduced insurance premium. You are given a list of providers who honor the P.P.O. program. Most patients assume that you must see a provider on the list only and this is NOT true. What insurance companies fail to convey, is that you can still visit the dentist of your choice BUT it will cost you more as a non P.P.O. dentist has not signed your insurance companies reduced fee contract.
  • Health Maintenance Organization (H.M.O.) – Also known as Capitation plans H.M.O’s are generally programs, by which you, as a patient pay little or nothing out of pocket for your dental needs. Your dentist, chosen off a list, is reimbursed monthly at a small flat rate per patient. This money is received even if the patient does not come in or has no treatment done. You must leave the dentist with whom you have established a relationship and choose a new dentist from a list supplied by your employer. Unlike a P.P.O. plan, you can only visit dentists who have contracted with the H.M.O.
  • Self Insured – Self funded and allows you to see the dentist of your choice without any restrictions.
 

An often misunderstood term used by insurance companies is “UCR”. This is an arbitrary fee ceiling at which the insurance company will stop reimbursement. After this ceiling, coverage for a particular procedure will cease. Again, this has nothing to do with the fee charged, but with the level of coverage negotiated by your employer.

Here is a good resource for learning more about various dental insurance terminologies.

This article is

Medically Reviewed by 

Dr. Smita Warrier

Dr. Smita Warrier graduated dental school in 2004 from Tufts University in Boston. She relocated to Charlotte shortly after and started her practice in Ballantyne in 2007. She is very passionate about dentistry and providing top-notch care to her patients. 

She is a member of the American Dental Association as well as local and state dental organizations. She feels very strongly about staying abreast of the latest technologies and treatment care modalities and dedicates many hours in continuing education. 

She has been an Invisalign certified provider since 2006.

16143 Lancaster Highway,
Suite 101
Charlotte, NC – 28277

704 544 5500

Mon – Thu: 8am – 4:30pm
Friday: By Appointment
Sat – Sun: Closed

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