Dentist takes insurance but not plan!

So last week I mentioned dental insurance and dental providers.

Regarding Dental Plans that can be offered. There are two different kinds:

  • DMOS, which are like HMOs.
  • PPL options

DMOS plans require that you do have to stay in the network to have any benefit.

I do not offer those, I only use the PPO options, because I want people to at least have a benefit, even if their dentist doesn’t take any insurance, or take their specific insurance. And here’s the catch. If your dental office accepts insurance, and they tell you, “We don’t take that plan”. That’s untrue. What they probably mean is that they’re not in the network.

If you have a PPO dental plan, all dentists can fill that for you. The amount they pay is the same.

But if they’re not in-network, you’re going to pay the difference between what the insurance pays and what the dentist charges.

So when they tell you, “We don’t take that plan”, you ask them, “Do you file insurance?”.

And if they say “yes”, then you say, “Then you do take my plan. You’re just out of network. And I need you to file it for me”.

It drives me crazy because this is what I used to do for a living. I used to run medical and dental practices and it’s just a training issue. And it drives me insane that they’re misinforming people. Insurances are already confusing enough. They should know. They just don’t take the time to know.

So remember, if you have a Dental PPO, you can use your insurance at any dental office.

You’re going to save money if you use a doctor in-network. But if the dentist is not in-network with any plans, and files, insurance, they can still file it for you.

If they don’t file insurance, you can still get reimbursed, if you ask for an itemization. And you take it, and you send it to your dental insurance, and they will reimburse you the amount they would have paid the dentist. Also, don’t wait to file your claim. I had that happen to a client the office told him to wait until the end of the year to file his claim. Don’t do that. File as soon as you have the work done so that you can get your reimbursement from the insurance.

If you have any questions or need assistance with health insurance, please feel free to reach out to me.

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Austin, Texas

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