Accidents are one of the major causes of death in the United States. Therefore, it should come as no surprise that a lot of accidents take place throughout the year, every year. Unfortunately, many people get injured, some quite seriously, and are left handicapped for life. Even if they survive and are released from the hospital, these people still require medical equipment to help them with their daily lives.
This type of medical equipment falls under the definition of “durable medical equipment” and includes oxygen tents, iron lungs, catheters, CPAP, wheelchairs, hospital beds and nebulizers. Most of this equipments is covered by health insurance plans.
In addition to those disabled by accidents, this type of equipment is also used by those disabled since birth and by senior citizens suffering from certain ailments or diseases. There are various companies supplying good quality and durable medical equipment with the commendable goal of assisting patients who have certain disabilities lead an independent life. Equipment such as electric scooters, rollators, grabbers and magnifiers also come fall under the “durable medical equipment” term.
As one seeks durable medical equipment to provide for those injured in an accident to help them with their daily activities, it is vital to ensure quality and durability. The reason is obvious: since a person’s life may depend on this equipment - or at the very least, a large portion of his life would be affected by it - it has to be be hundred percent safe and comfortable.
There are various companies providing durable medical equipment of high quality for patients. These include the Total e-Medical, Durable Medical Equipment, to name a few. Most of these companies operate with customer satisfaction being a primary goal and provide excellent quality equipment as well as fantastic service after the sale has been complete.
It is important to emphasize that particularly after an accident, it is essential to ensure the patients’ get their durable medical equipments delivered on time. Almost all companies supplying this equipment train their staff to be courteous and offer the most dedicated service. Something quite unusual in these times.
What happens if you need durable medical equipment?
In the unfortunate event you have been in an accident and have become disabled, you should look for a reliable supplier of durable medical equipment. One of the primary resources for finding the best suppliers in your area is the Internet. There are various companies that can be located online (and this website aims to provide links to many of them). Furthermore, you can compare prices and features of the equipment you are looking for, and order the most appropriate one for you. Finally, if you have a specific query or issue that needs to be addressed, you should always attempt to contact companies online - most will respond and may even get their sales executive to come and meet you in person.
Once they arrive, these sales people will be able to provide useful advice regarding the best equipment that is most suitable for your requirements. Note that your doctor should be involved in this decision making as well. Once you have made a decision on which equipment you are interested in obtaining, they will deliver it to your home. Finally, if there is ever a problem or a malfunction in the equipment, these companies will also provide you with excellent backup service.
There are other alternatives. There are numerous support groups online, such as Yahoo Groups, Google Groups, and forums dedicated to certain subjects. These provide excellent resources for asking questions and getting extremely useful information with regards to medical equipment and its suppliers. In fact, many times this information can be more useful than what the doctor suggests, as the people who give answers are the people who are actually use these machine in their day-to-day lives.
One final source of information with regards to durable medical equipment suppliers is - perhaps surprisingly - the local yellow pages. You can just contact a few of these companies over the phone and get a quote and features of the desired equipment. After comparing the brand, quality and price you can settle on the company that offers the best deal. Choose your durable medical equipment with care as, sadly, this might be a lifelong companion.
My Online Medical Supplies offers a wide range of medical equipment and supplies, including:
- Quality Medical Equipment, free shipping on orders over $100
- Mobility aids for you or your loved one - Walkers, rollators, wheelchairs, canes and more.
To see the full list, visit our medical equipment and supplies section.
What are HIV and AIDS?
Is there a person who has not heard HIV (which stands for Human immunodeficiency Virus)? We highly doubt this fact. HIV has been first discovered in 1981, and it is assumed that as of January 2006, it has killed more than 25 million people. Infection with HIV can occur through several different ways, all involving some sort of transfer of bodily fluid (which can be blood, semen and breast milk, to name but a few).
Most people who contract HIV eventually develop AIDS (which is almost synonymous with HIV, even though it is not the same thing). AIDS stands for acquired immune deficiency syndrome, and basically means that at this point, the HIV patient’s immune gradually becomes weaker over time, to the point where the individual is extremely susceptible to illness and tumors. This can manifest in a variety of ways including pulmonary infections, gastrointestinal infections and even have neurological and psychiatric effects. It is very likely to eventually lead to the individual’s death.
Is there a cure?
Although there is no vaccine or cure for AIDS or HIV, there has been a lot of progress made in the decades since HIV’s discovery. Consequently, there are effective antiretroviral methods which can slow down its progress, as well as reduce its mortality rates.
Since a person who has contracted HIV may unwittingly transfer it to another person which most commonly happens during sexual intercourse, it is very important for individuals who suspect they may have HIV to get themselves checked. There are multiple types of tests, including ELISA, western blot, and rapid or point of care tests.
That being said, it is important to remember that HIV tests are not perfect, and at times may produce false positives, meaning, the person is actually healthy but the test reports he has HIV, as well as false negatives, meaning, the person is infected with HIV but according to the test he is healthy.
However, the accuracy of HIV testing is getting increasingly better. In 2005, using a western blot HIV test, the chance of a false-positive is roughly 1 in 250,000.
There are several organizations that provide this anonymous and confidential HIV testing. These tests can be done using urine samples, blood samples or even saliva samples. Furthermore, there are also home testing kits which can be used at home.
In conclusion, if you suspect you may have contracted HIV, get yourself checked. It is crucial, not only so you could obtain treatment for yourself, but also so you do not infect your partner or family accidentally.
Modern medical science is continuously devising new ways to keep us healthier and live longer, but this comes at a cost - health care has now become more expensive. Here are some proven and useful tips which will help you in cut your health insurance costs:
First, Health insurance can be purchased individually or as a part of group policy. Group Policies are arranged and purchased by employers and associations for their employees. If purchased in bulk they come at a cheaper price. The administration costs involved are reduced and employees have to pay only a part of the premium thus cutting their huge health insurance bills. Consequently, if you have a choice, go with a group policy offered by your employer.
Second, Through group health insurance policies employees can also cover their families’ health care facilities as well. This is signicifantly cheaper than purchasing health insurance individually for each family member.
Third, Shop around: compare the various Health Insurance Plans. Different health insurance plans may offer different premiums. The quote you will get are likely to be different, and assuming all are equivalent, you could simply go with the cheapest. When doing this assessment, examine in detail coverage and the features of the plan, including limitations and exclusions if any. For example, if you had to make frequent visits to a specific type of doctor (i.e. a psychiatrist), verify whether they are covered in the health insurance plan, and whether there is a certain quota to these treatment. You can compare rates of 100 providers using this link. As for comparison of medicare rates, use this link.
Fourth, This continues the previous item, when assessing the various health plans, make sure you take a plan that suits you. For example, if you are generally a healthy person and rarely need to see a doctor, you may opt to go with a plan that is less flexible, offers a higher co-payment but significantly lower premiums. Similarly, if you don’t wear glasses, and have good eyesight, you probably don’t need a vision insurance plan.
Fifth, Order prescriptions through mail: it is possible to order several months’ worth of supply by ordering prescriptions through a prescription drug plan (covered in one’s health insurance). This will definitely save you money. Likewise, most of the pharmacies offer discounts on bulk purchases as well.
Sixth, Use Generic Brands: Discuss your financial needs with your doctor and ask him whether he could prescribe generic drugs rather than brand names. Generic drugs are claimed to be as effective, only much cheaper, than their brand name counterparts. Note that certain companies enable getting free samples of pharmaceutical products as well as discounts and coupons.
Seventh, Check the accuracy of the Bills: although this may seem like common sense, most health insurance bills are overly complicated. Therefore, check each item in the bill, verify its correctness, and whether this should have been fully covered by your plan or not. It is very possible the insurance company has accidentally overcharged you due to a mistake, and a simple phone call can rectify this error.
Eighth, Plan ahead: according to current IRS rules it is necessary to itemize the deductions. Your total medical expenses must go beyond 7.5% of your adjusted gross income. Once you reach this threshold, you can deduct various medical expenses when filing taxes. When filing taxes, it is possible to include medical expenses which cover a wide variety of treatments: from basic health care services to hearing aids as well eyeglasses. Make sure you keep track of these expenses so you could later claim them in your annual tax return.
Ninth, Consider preventative care: some insurance plans offer workshops that aim to improve your health in general, such as Tai Chi. Participating in these may not only increase your health, but also reduce your future health care bills.
Tenth, Use free health screenings: often, local hospitals offer health screenings for free such as for cholesterol and blood pressure. By participating in these you could save money.
An individual can guarantee that funds will be available to pay for his or health care benefits, if necessary, by routinely paying a premium (which can be on a monthly or an annual basis).
Until the 1970s, the majority of individuals received standard insurance coverage. Nowadays these plans are known as “fee-for-service” plans. Similar to auto insurance, indemnity plans require you to pay a deductible to cover a portion of your medical expenses. The insurance company then will pay the remaining, albeit sometimes not all, of the balance. Modern medical science is continuously devising new ways to keep us healthier and live longer, but this comes at a cost - health care has now become more expensive.
Fee-For-Service
Indemnity or fee-for-service coverages have been the industry’s standard for decades. The benefit of this type of health plan is that a person may choose his own doctor or hospital. Furthermore, he can refer himself to a specialist without getting approval and, as long as it’s an in-network provider, enjoy the same co-pay. No referral or approval is required to make such an appointment with a physician. That being said, there are limits: for example, a person may require approval to visit the emergency room, unless some circumstances, such as being incapacitated, prevent him from doing so.
The negative aspect of fee-for-service plans is that they normally require higher out-of-pocket expenses. Frequently a deductible exists, typically around several hundred dollars, only after which the insurance provider begins paying. After this threshold has been reached , the insurance provider usually pays most (%75-80) of the doctor’s fees. It may also be necessary for a person to pay immediately and send in a bill in order to receive reimbursement. Alternatively, the physician himself could bill the insurance company directly.
Generally, insurers will pay solely for medical expenses that are considered to be “reasonable and customary” when under fee-for-service plans, take into consideration the average fee that similar practitioners charge for equivalent services. If an individual happens to be billed by a physician that charges more than what the insurance company has defined to be acceptable, he will likely need to pay the difference in costs on his own.
Interestingly, fee-for-service plans have tended in the past to not cover preventative care services, such as annual physicals, but an increasing number of insurance providers are now beginning to include preventative care services, as growing evidence suggests that in the long run, this will actually save them money (i.e. prevent a man from smoking, and he may not need expensive cancer treatments 20 years from now).
Fee-for-service plans often have a maximum limit for out-of-pocket expenses; once that maximum amount has been reached they cover the rest of the bill themselves. It goes without saying that the maximum amount is normally high.
In summary, fee-for-service plans provide more options in exchange for increased out-of-pocket costs, higher premiums and more bureaucracy.
Managed Care
As popular as managed care has become in the past decade, it actually originated in the 1930s, and has been with us in various forms since then. As the health care insurance industry evolved, we were presented with three varieties of managed care plans. Nowadays, most individuals with private health insurance also participate in some variation of managed care.
While there are some key differences among the various forms of managed care plans, they share common elements. Specifically:
- An arrangement exists between the insurance company and a network of health care providers.
- The insured individual gets significant financial incentives to use the providers within this network.
- There typically are specific guidelines for choosing medical professionals and a formal procedure to assure high quality of care.
Health Maintenance Organizations (HMOs)
Most discussion about HMOs are about closed-panel HMOs, which are the cheapest but most rigid health plans available. These plans are structured for group plans as opposed to individual plans. This comes in exchange for a lower - or no - co-payment due at the time of the doctor’s visit.
Although HMOs plans have lower premiums and require less paperwork, members are limited to the health care providers in their network, and their primary care physician must refer them to specialists if they want to see one. Furthermore, as long as one is physically capable of doing so, he is also likely to require approval in order to go to the emergency room (an inconvenience to say the least!).
HMO plans may offer central medical clinics; alternatively, they may comprise a network of participating individual health care providers. Normally, a member is required to use HMO-approved doctors, otherwise he will pay all fees himself. As far as consumer impressions, HMOs beat out the competition in programs for preventative care and health improvement, but this comes at a great reduction in flexibility.
Preferred Provider Organizations (PPOs)
PPOs offer more flexible plans than ’standard’ managed care. PPO plans have a network of health care providers with which they have agreement that the latter will charge lower fees. As is the case with managed care, PPOs also give their insured individuals a financial incentive to use health care providers within their network. To illustrate, going to an in-network health care provider may require a $15 co-pay. However, in order to see an out-of-network health care provider, insured individuals would have to pay all medical expenses on their own and then submit a claim for typically an 75-80% reimbursement. In some cases there will also be a deductible payment required for service outside of the network or at the very least, the insured individual would have to pay for the differences in the costs between an in-network and an out-of-network treatment.
That being said, one advantage of a PPO is that the insured individual can see a specialist in-network doctor without getting prior approval and pay the standard co-pay. In other words, using in-network doctors means cheaper treatments and less bureaucracy. On the down side, PPO plans typically do not cover preventive care programs.
Point-of-Service (POS)
POS plans are like a PPO plans, but they uses a Primary Care Physician (a PCP) as a ‘gatekeeper’ for services. The plan will provide each member a list of doctors to choose a PCP from. Similar to PPO plans, going to an out-of-network doctor is still possible, and the insured individual will be partially reimbursed for the costs. However, this comes at a price; if one wishes to see a specialist, he typically must be referred by his PCP (and that is why he is called the ‘gatekeeper’). One can ‘bypass’ the gatekeeper, but it will result in higher out-of-pocket costs and far more bureaucracy.
If a participating physician agrees to refer an individual to an out-of-network health care provider, the insurance plan normally pays most of that cost. however, if he or she goes to an out-of-network health care provider without a referral, then most likely they’ll receive a smaller reimbursement and have to deal with far more paperwork. The insurance provider may also charge a deductible if one sees a provider outside of their network.
One additional advantage of POS plans is that they often cover more preventative care services, at times even programs such as workshops on nutrition, Tai Chi classes, and smoking cessation.
Exclusive Provider Organizations (EPO)
EPOs are PPO Plans that ‘feel’ like HMO plans. EPOs make it even more attractive for insured individuals to seek medical treatment within their network. For example, even though going to an out-of-network health care provider is possible, the insurance plan will not cover anything: the insured individual will have to pay entire cost of the treatment on his own.
In a previous article, we introduced the reader to basic concepts in health insurance such as PPOs and HMOs. Here we try to answer how to use this knowledge to pick the most appropriate family health insurance plan.
Our first recommendation would be to follow the guidelines presented by our article, Tips on Cutting Your Health Insurance. By following these guidelines, it is almost certain one can reduce his and his family’s health care costs. Perhaps most importantly, as one of the tips suggests, it is shop around for various health plans and receive multiple family health care plan quotes. This gives a good starting point for considering plans, as getting the best plan for the lower amount of money provides one with the liberty to take other special considerations into mind. You can compare rates of 100 providers using this link.
One challenge that exists for getting family health insurance plans is that it depends on each member’s medical history. This is referred to as ‘pre-existing condition’. A pre-existing condition is an illness or injury that the family member has been treated for in the past, before applying to the current insurance plan. Although certain providers have different rules, normally there is a waiting period before becoming eligible to receiving treatment for this condition. However, this also depends on the previous type of coverage one held before.
Pre-existing conditions are a major factor in determining whether an insurance company will agree to cover one’s family, as well for the final cost, which depends on the risk the insurance company assigns to one’s family.
Useful tips:
- Most importantly, one must select the plan according to his family’s current and future expected needs. For example, if a family member may need to see specialists often, it might be advisable to go with a PPO plan that gives the liberty to go to a specialist without requiring a referral. Being covered in a plan which has a primary care physician (a ‘gatekeeper’), such as POS plans, can be a real problem at times, as the doctor might not agree that the issue requires seeing a specialist. Speaking from personal experience, this can be a very frustrating experience.
- An additional point is receiving second opinions: clearly when one requires approval to see a specialist, he may not get it twice unless he has a very good reason (just saying “I don’t trust that doctor’s opinion” is probably not good enough to convince the primary care physician). Going with a PPO gives the liberty to receive multiple opinions by specialists. However, if one does not expect to face this issue, then going with a different plan may be a better – and certainly cheaper – option.
- Preventative care: this can be an issue at times. For example, if a family is expecting to have children, and the plan offers maternity classes, then it is important to keep in mind. Normally HMOs are far better than PPOs in their preventative care offerings, so this is yet another issue to keep in mind.
- Dental plans: some providers offer dental plans in addition to the ‘standard’ health plan: this could be very useful in saving money, but it is important to take it only if one believes this may actually be used (though of course, certain things are out of control and cannot be predicted). Note that these plans normally offer very limited coverage, so if facing numerous dental issues, the plans won’t be of much help.
- Since insurance plans periodically change, it is important to make sure to follow up on these changes and the coverage that is being received in order to know that you are getting the most at the best rates; perhaps at times it might be a good idea to switch plans.
- Finally, it is important to remember that a cheap plan that does not protect you or a family member from major illnesses may not be worth it. Life is precious, and to face a horrible disease without the ability to pay for treatments is a terrible scenario to be in.
In conclusion, it can be said that it all comes down to the delicate balance between cost, flexibility and availability. If one predicts having to see multiple specialists, and can afford to take a PPO, that may be the best choice. However, if for a small, young, family that is generally healthy, a basic HMO plan may be the best one for you. An additional issue is preventative care: since HMOs are better at this aspect, this should also be taken into consideration.
Formerly branded as High Deductible Health Plans (HDHPs), Catastrophic Health Insurance plans were initiated with the sole aim of providing overall medical costs at a reduced monthly premium in lieu of a higher annual health insurance deductible in the United States.
These plans are the cheapest of all health insurance plans, and for a reason: a policy holder of a catastrophic health insurance plan would pay for all medical care until he reaches the annual deductible amount, which tends to be high or even very high. Only afterwards, his health insurance coverage begins and his insurance would begin paying for his medical expenses.
What does a Catastrophic Health Insurance Plan covers?
Historically, these plans didn’t cover routine medical care and that is why were called ‘catastrophic’; they were truly intended for extreme scenarios. Consequently, they normally required lower monthly premiums and high annual deductibles. That being said, many modern catastrophic health insurance plans offer routine care and even prescriptions (in other words, non-catastrophic care); as a general guideline, the more the plan covers, the higher the premium – however, paying more out of pocket, results in lower monthly premium.
Note that these plans tend to have a lifetime maximum benefit, also called a ‘cap’ which is somewhere between $1,000,000 and $3,000,000. After reaching this cap, the insurance company no longer pays any additional costs.
When do you need a Catastrophic Health Insurance Plan?
As the name suggests, these plans were historically a targeted towards people who were not too concerned with routine care, or at the very least, could afford to pay it, but wanted to protect themselves from a situation where they would need a very expensive treatment (a ‘catastrophic’ scenario), which then their insurance would pay for. So for example, a man could pay for all his doctors’ visits on his own, but still have the insurance pay for costs of the expensive surgery he needs after he reached his high deductible (which could be as a high as, say, $4,000 a year).
Consequently, if the goal is saving money, one really needs to carefully and responsibly consider the likelihood of needing routine care vs. the likelihood of needing a very expensive treatment. In a specific set of scenarios, it might prove to be cheaper, but in others, it would not. Either way, the policy holder takes on more risk since he essentially ‘gambles’ that the annual costs of his medical treatments would be significantly lower than his annual deductibles; otherwise, there would be no incentive for him to take this plan, since he’d end up both paying for his medical bills and paying monthly premiums (albeit cheap ones).
Is this plan for you?
This plan is probably suitable for people who don’t believe they will require a lot of medical treatments, but want to insure themselves against the situation where an extreme situation occurs, and they will be faced with enormous bills. For some people, this might be a wise course of action. Either way, as stated, one needs to carefully weigh the pros and cons before selecting this plan; the worst case financial scenario is that one just reaches his annual deductible, meaning, he pays his entire medical bills on his own, and yet still has to pay the monthly premiums to the insurance company.
According to health statistics, the people who pick this plan tend to be split into two groups: a group of young people who tend not to incur a lot of medical expenses because they are healthy, and thus, can afford to carry on this risk; and conversely, a group of people close to retirement age – and yet still not eligible for Medicare benefits - that can easily afford to pay most medical costs, but would not be able to afford treatments for serious conditions (such as extremely expensive cancer treatments).
Note that some individuals aren’t qualified to enroll on an individual catastrophic health insurance plan, for example, people with certain pre-existing conditions such as AIDS or diabetes. However, they can be covered under a group plan - though they may be subject to wait a certain period of time, depending on the policy.
Click on the image above to receive a quote for Maternity Health Insurance.
Although it is important for everyone to possess health insurance, it is particularly important in the context of pregnancy. The reason is obvious: there are many things that can go wrong during pregnancy or could be made better if the woman is aware of certain facts.
This not only affects the unborn child, but the pregnant women as well. For example, certain types of abnormalities or genetic diseases can be discovered in advance if screened for. Additionally, certain risk factors could be assessed and be taken of that could endanger the baby once born. Furthermore, since there is always some risk involved during a pregnancy for the women, it is wise to continuously monitor the state of the pregnancy to make sure all is well. Therefore, it is essential that pregnant women periodically receive check-ups in order to make sure the pregnancy is progressing properly and there are no detectable problems with the unborn child or the woman herself.
Unfortunately, many pregnant women do not have health insurance. It has been statistically shown that when they deliver, their babies are more likely to have low birth weight and higher incidents of death.
Obtaining health insurance coverage for uninsured pregnant women has become even more challenging today because of the towering costs of health insurance in the United States. According to the American Health Association, 41 million Americans are not insured, and around 13% pregnant women in the country do not possess any form of health insurance. This puts these women and their unborn children at unnecessary risk.
Prenatal checkups can be very expensive, not to mention hospital and delivery charges which could cost $10,000 or more. Furthermore, if there are complications, such as premature birth or the need for a cesarean section operation, the costs would be much greater. Therefore, it is strongly recommended for a pregnant women to obtain health insurance.
The problem is that most health insurance companies do not accept new insurance policies from pregnant women whose pregnancy has been assessed as a pre-existing condition. Ideally, if you are a woman and you know you wish to get pregnant, things would be much easier for you if you got health insurance before you got pregnant. But as is the case in life, often the unpredictable occurs, so if you are uninsured and found out you are pregnant, here are some useful tips that could help you obtain health insurance:
First, shop around – search the internet – for health insurance companies who can provide pregnancy health coverage and discounted health care coverage. It is easy to get free instant quotes from multiple providers. In fact, this site offers a way to shop around for maternity health plans: Click here to receive a quote.
Second, there are some federally funded programs which offer healthcare coverage for low income people. Medicaid, for example, allows you to enroll in a health insurance plan even when you are pregnant. An additional program is CHIP. Some states have specialized programs for this purpose: investigate whether your state offers one.
Third, look for additional benefits provided by other agencies. WIC is a federal agency that offers health services to low income women and children under 5, and also provides food supplements.
Finally, if you are in a position where you have several options, make sure you choose your plan carefully: choose the plan which covers all the benefits you may require. For example a hospital-only plan will not cover visits to a physician’s clinic.
Note that if you are a pregnant women that possesses insurance and wishes to travel abroad, you may want to check our article Travel Insurance and Pregnancy.
The primary goal of any type of insurance plan is to protect people from financial hardships when the need arises: whether related to auto, life, health or dental problems, there is a common element in all these types of insurances.
In this article we discuss dental insurances, which protect insured individuals from unexpected dental problems, as well as offer additional services. According to American Dental Association (ADA) less than half of the population of the United States is covered by a dental insurance plan – these people mostly gain this benefit through their employer.
Similar to medical health care plans, dental insurance plans can be categorized into PPO and HMO plans. Before reading this section, it might be a good idea to read our article Introduction to Health Insurance Plans to better understand the concepts of HMO and PPO, which apply here as well. That being said, there is one big and important difference in HMO and PPO dental plans which affect the way dental care providers view their patients. Put concisely, participating dentists are paid differently in HMO and PPO plans.
- In PPO dental plans, in exchange for patient referrals from the insurance providers, dentists agree to offer lower rates to these patients. That being said, the dentists are fully paid for their services.
- In HMO dental plans, dentists receive a predefined salary every month. This means that the less time the dentist spends on HMO patients, the more profitable this arrangement is. Clearly this has the potential of patients receiving less than ideal care: shorter visits, quicker treatments, and longer waiting times. It doesn’t have to be this way, but the potential exists.
HMO Dental Plans
HMO Dental plans are very similar to their medical counterparts and are also called Capitation Dental Insurance Plans. In this type of plan the insured person pays a monthly premium, and gets dental treatments from a given list of dental care providers when he requires them. Using a dentist that does not belong to the network will not be covered by the dental plan.
HMO dental plans cover a yearly dental exam and necessary X-rays, as well as periodical cleanings, generally for free. In addition, they partially cover more advanced dental procedures such as crowns, bridges and dentures – the rest of the cost is covered by the insured individual himself.
An additional important point is that HMO dental providers cannot turn patients away.
PPO Dental Plans
PPO Dental plans are very similar to their medical counterparts as well. These plans also offer a network of dental providers, and the insured individual is encouraged to use dentists from the list. The advantage to these plans is that the dentists offer cheaper rates for patients coming from the plan. The insured individual also has the option of going to an out of network dentist, but then he will be charged with more expensive bills (at times even significantly more) or receive fewer benefits – these can make a real difference.
The advantage of PPO plans is that that they enable the insured person to see any dentist he wants, but using a dentist that is in-network offers cheaper treatments. Furthermore, as stated before, PPO dentists are known for giving better service because of the way they are paid. An additional advantage is significantly lesser bureaucracy: normally the dentist is able to fill all the paperwork for the patient.
That being said, PPO dental plans usually require the patient to pay a deductible, normally around $50 (though some don’t require any deducible), and additionally PPO dental providers, unlike HMO dental providers, have the right to turn some patients away. Furthermore, PPO plans also tend to be fairly restrictive and offer maximum yearly coverage (often as low as $1,000, which barely covers the cost of one crown). At times there’s also a ‘life limit’, meaning, an amount in which the coverage stops afterward.
If you’re shopping for dental plans, you’ll find our dental plan section interesting.
As illustrated in our previous article, Introduction to Dental Insurance Plans, there are significant differences between PPO and HMO dental plans. In addition, just like medical health care plans, there are numerous types of dental plans. When choosing a plan one must take the following items into consideration:
- Medical plan bonus: many medical insurance plans offer the option of including a dental plan as well. Even if your teeth are in perfect health and you don’t feel you need it, it is good idea to enrol in a dental plan. The premiums tend to be fairly low, and certain unexpected scenarios (i.e. falling down and breaking a tooth) can affect even the healthiest of teeth.
- Quality of care: as explained in the previous article, the different pay structure for dentists that belong to PPO and an HMO dental care plans may result in different quality of care, including quality of treatment and amount of waiting. This is an important consideration that must be weighed in before one chooses a plan.
- Scheduling: some dentists (often those who work with HMO plans) offer a limited scheduling – both in days and times – for individuals covered under the plan. Make sure these can fit into your schedule.
- Size of provider network: some dental insurance providers have a large network of dental providers, while others have a smaller network. This has to be taken into consideration, particularly when thinking of specialists (such as root canal specialists, gum specialists, and so on). Having a very small set of options might really limit the usefulness of the plan. Furthermore, if there is a specific dentist you want to be treated by, and he does not appear in the list, then it might be a good idea to look at a different offering – regardless whether the plan is PPO or HMO.
- Coverage: depending on the dental insurance, the amount of coverage varies for different type of dental treatments. One should consider his dental health when picking a dental insurance plan: the cheapest may turn out not to the best. Most decent plans offer at least one free exam and related x-rays as well as two free teeth cleanings per year.
- Cosmetic dentistry: often these are not covered by the plans, and one should keep this in mind. For example, if your child requires braces, which is an expensive treatment that takes years, or you wish to undergo teeth whitening, than perhaps it may be a good idea to go with a plan that covers these – at least partially.
If you’re shopping for dental plans, you’ll find our dental plan section interesting.