Dentist in Green Cove Springs FL
At Asbury Family Dentistry, a Dentist in Green Cove Springs FL, we understand the need for options when it comes to dental treatment and in your dental coverage. Below is a list of different dental insurance options and their descriptions. We hope this helps you in choosing the dental coverage that is right for you and your family.
Indemnity Plan: [HIGHEST COST]
An indemnity plan allows consumers to receive services from any dental provider. There are no ‘network’ provisions, and consumers are reimbursed for a specific amount of a service rendered, regardless of who provides it. For example, when someone covered by an indemnity plan receives a dental cleaning, his or her plan pays a flat amount for the service. Any charge above that amount is the consumer’s responsibility.
Indemnity plans can be more costly; however, these plans can be more flexible, especially for people living in rural areas or locations where a traditional PPO network is not as robust. Note that this is not the case with our office as Dr. Stone participates in most PPO plans (which are discussed below).
Dental Health Maintenance Organization (DHMO): [LOWEST COST]
When a dentist signs a contract with a dental insurance company that dentist agrees to accept a certain insurance fee schedule and give their customers a reduced cost for services as an In-Network Provider. With a DHMO, you must select and be assigned to a primary care dentist. When you do visit your ‘assigned’ dentist there may be nominal co-pays or co-insurance; however, the bulk of the dentist’s reimbursement comes from ‘fixed fees’ paid by the insurance company. Generally your assigned dentist receives a fixed fee from the insurance company, regardless of how many times you see him or her during the year. In this respect, some view DHMO’s as providing a ‘disincentive’ for the dentist to see you and provide dental treatment.
Participating Provider Network (PPO): [MEDIUM COST]
PPO plans are much more versatile than DHMOs. Instead of a DHMO (where you are assigned a dentist) under a PPO plan you choose the dentist you wish to see. You can choose a dentist who is ‘In-Network’ or one who is ‘Out-of-Network’.
An In-Network dentist has a contract with your insurance company. This In-Network contract means you will be paying for services at lower, negotiated rates. The dentist is not allowed to charge you anything in excess of the pre-negotiated fees. Two things happen when you see and In-Network dentist:
- Your overall fees are lower;
- In addition, the insurance company will cover a greater percentage of the treatment.
For example, with an In-Network dentist coverage for fillings may be 80%, whereas if you see an Out-of-Network dentist the fee will be higher and the coverage on those higher fees might only by 50%.
IMPORTANT: When you are looking for a dentist, remember to ask if the dentist is ‘In-Network’. The office you are calling may say they ‘accept’ your insurance—this is not necessarily the same thing as being ‘In-Network. Be sure to clarify…In-Network or Out-of-Network?!
In addition to co-pays and co-insurance most PPO plans have an annual maximum benefit limit. Thus, once the annual maximum benefit is exhausted any additional treatments may become the patient’s responsibility. Each year the annual maximum is renewed. The renewal date may vary as a calendar year, company fiscal year, or date of enrollment based on your specific plan.
Dr. Stone is a PPO provider. She is In-Network with most PPO insurance companies.