Dental Opinions: What you need to know about HMO and Dental Claims.
If you have an HMO: One significant benefit of an HMO dental insurance plan is that there are no claims to file. The cost of dental procedures is usually fee-based. The dentist will charge based on the fees laid out under the HMO plan. Therefore, you know the price of the services before having them done.
However, service costs may differ from what you think the charge should be. Take a crown as an example. There are many different types of crowns; therefore, knowing what kind of crown you will have is essential in understanding your cost and if your HMO plan covers it. That is where ADA codes come in. There is a different ADA code for each dental service, so even though there are many crowns, the ADA code is different for each crown type.
When questioning the cost of services, ask your dentist for all the ADA codes that will be provided so you can match them to the insurance company fee schedule. If the dentist charges the highest crown cost or a crown not covered by your plan, you may want to question why. It is up to you to know your benefits and ask questions if things do not match up how you expect them to.