An In-depth Comparison Of Traditional Dental Insurance To DMPOs - Part 2
By Joseph Preziosi Jr., DMD
This is the second in a series of three articles that compares traditional indemnity dental insurance (TIDI) to discount medical provider organizations (DMPO). The first article listed the limitations on these different policies and this article will go into an in-depth point-by-point comparison of the policy limitations 1 through 8. The third article in this series will deal with limitations 9 through 18 in the same detail that this article deals with the first seven.
- With DMPOs there is no limit to the amount a patient can save, the more the treatment costs the more the savings will be. With most traditional indemnity insurance (TIDI) the patient can receive at most $1,000 in compensation in any given benefit year. To qualify for the $1,000 in benefits the patient must incur a dental bill of about $3,000, thus leaving them with an out of pocket expense of $2,000 for the first $3,000 worth of dental treatment and any additional treatment being completely out of pocket for the patient. A patient seeing a DMPO doctor who gives a 33.3% discount would have the exact same $1,000 of savings and $2,000 out of pocket expense for the first $3,000 worth of dental treatment and continues to save 33.3% on all treatment above the $3,000 with no limits in this example. So anyone needing moderate restorative treatment or more will have less out of pocket expense with DMPOs than TIDIs. A patients exact saving will depend on their TIDI annual maximum benefit and the discount rate of the Cinergy doctor treating them.
- With DMPOs there is never any deductible so the savings start with the very first dollar a patient spends. With TIDI typically the first $50 to $150 of treatment is out of the patients pocket and goes to satisfy the policy’s deductible.
- With DMPOs there are never any dental treatment that is excluded from the discount rate so the patient saves on any and treatment they receive. TIDI does not pay benefits on all dental treatment regardless of weather it is necessary or not.
- With DMPOs there are no frequency limitations so all treatment is discounted all the time. With TIDI once a benefit is paid on a treatment procedure there is a minimum time limit that must elapse before benefits for this same procedure will be allowed again. An example of this is that once the benefits for a crown are paid most TIDI policies will not pay benefits for an other crown for 5 to 7 years regardless is it is broken or caries (decay) has infected to tooth.
- With DMPOs there are no pre-existing condition exclusions for treatment so all treatment is discounted all the time. With TIDI some policies will not cover conditions that the patient had prior to their coverage date with the TIDI.
- With DMPOs all treatment is covered and discounted whether it is medically necessary or if it is elective and or cosmetic. TIDI policies do not cover cosmetic and or elective treatment such as bleaching or laminate veneers.
- With DMPOs there is no waiting for your saving they are instant. With TIDI patients must wait anywhere from a few weeks to many months to get their reimbursement checks, and the larger the claim and expected benefit check the longer the wait.
- With DMPOs there is never any documentation necessary, in fact there is no paper work at all. With TIDI even after they receive a claim form for treatment rendered they will often ask for more documentation for the patient and or doctor before the decide weather to pay benefits or not.
About the Author:
Joseph Preziosi Jr., DMD
New Jersey Cosmetic Dentist
phone. (908) 654-7100
fax 908-654-8764
email: Drpreziosi@aol.com
url: http://www.preziosidentistry.com/
