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DPPO plans means you don't need a primary care physician. You can go to any health care professional you want without a referral-inside or outside of your network. It give you flexibility.
Staying inside your network means smaller copays and full coverage. If you choose to go outside your network, you'll have higher out-of-pocket costs, and not all services may be covered.
If you prefer to have your care coordinated through a single doctor, an HMO plan might be right for you. If you want greater flexibility or if you see a lot of specialists, a PPO plan might be what you're looking for.
Wiki User
∙ 8y ago
Wiki User
∙ 8y agoA DPPO is a "Dental Preferred Provider Organization". It works similarly to a PPO for medical care but applies to dental services. Analogizing to a medical PPO, it provides greater choice as to the provider used. Keep in mind that frequently, dental plans are not indemnity plans. Instead, they pay a fixed benefit depending upon the dental care furnished.
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What happens if primary insurance is PPO and secondary insurance is HMO?
When a DPPO is primary coverage, the charges paid by the patient are based on the agreed DPPO discounted fees--not the DHMO schedule of charges. The dentist would bill the DPPO for the procedures performed. If the dentist is in the DHMO network, he or she would also get his or her regular capitation payment for that patient.
What's the average cost for individual dental insurance?
The average monthly cost for DHMO dental insurance is $14.19 a month. The average monthly cost for DPPO dental insurance is $43.64 a month. You can expect to pay around $1 per day for dental insurance.
Do the primary dental insurance rules govern the allowed charges from the dentist?
The answer to the question, is it depends. State laws on coordination of benefits (CoB) can impact the answer, but there is a general rule of thumb. If the dentist participates in a network that is connected to the patient's coverage--whether that coverage is primary or secondary, the participating network contractual relationship determines the amount that can be collected from the patient.Here's a table that was developed by the National Association of Dental Plans outlining various CoB scenarios and what determines the charges to patients under each.PATIENT COVERAGEWHAT THE DENTIST CHARGES THE PATIENTPrimary and secondary coverage are both DPPOs; Office participates in both network plans.The DPPO allowances of the primary plan.Primary coverage is a DPPO, and the secondary coverage is an indemnity plan.The DPPO allowances of the primary plan.Indemnity plan is primary, and the secondary coverage is a DPPO.The DPPO allowances of the secondary plan. Primary coverage is an DHMO, and the secondary is an indemnity plan.The DHMO patient co-payments. (The secondary indemnity plan may cover all or most of these co-payments.)Indemnity plan is primary, and the secondary coverage is an DHMO.The DHMO patient co-payments. (The primary indemnity plan may cover all or most of these co-payments.)Primary coverage is a DPPO, and an DHMO is the secondary plan.The DPPO allowances of the primary plan.Primary coverage is an DHMO, and the DPPO is the secondary plan.The DHMO patient co-payments. (The secondary DPPO plan may cover all or most of these co-payments.)NOTE: Discount dental plans are not subject to COB laws and regulations as they are not insurance products.
Can you combine a Dental HMO and a Dental PPO?
If you mean that you are covered under both types of policies and want to know whether you will receive benefits under both, you should know that each state has laws related to "coordination of benefits" which dictate which policy will pay 1st and which one pays some portion of any remaining cost. There is a national standard set by the National Association of Insurance Commissioners that most states follow. The Coordination of Benefits standards 1st determine what coverage is primary. If you are employed, this is usually the coverage where you are the policyholder. The secondary coverage would be the one where you are a dependant--like your spouse's coverage. After that is determined, it is the dentist's contractual relationship with the patient's primary plan that determines the amount that can be collected from the patient and what is paid by the carrier. So, if the DHMO is primary, then the patient only pays the co-payments and some of that may be reimbursed by the secondary DPPO. If the primary carrier is the DPPO, then the DPPO pays the contracted portion of the fee to the dentist and the patient has the coinsurance amount--usually 20% for basic care and 50% for major procedures. The DHMO, as secondary carrier, would not pay any portion as their plan is superceded by the contractual relationship of the DPPO.
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