dental care

EPO Health Care Plans
An Affordable Dental Care Option

EPO Health Care Plans EPO health care plans, or Exclusive Provider Organization, are types of dental insurance that provide you with an affordable way to receive proper dental care.

To maximize the benefits out of an EPO health care plan, you should first know the nature of this type of plan.

The Facts on EPO Health Care Plans

A few important points to note about EPO health care plans:

  • What is an EPO health care plan?
  • The difference between an EPO and an HMO
  • Coverage of an EPO health plan
  • How to claim from an EPO

1. What is an EPO health care plan?

EPO health care plans are based on dental EPOs, which refer to a network that consists of many health professionals such as dentists who enter into a partnership with an insurance company to offer policyholders with discounted dental treatments. The amounts discounted from the original costs of dental treatments are shouldered by the insurance provider. Take note, however, that you will only get discounts when you visit dentists that are included in the plan.

2. The difference between an EPO and an HMO

EPO health care plans are slightly similar to HMO dental plans. The main similarity is that policyholders of both plans can only avail of discounted rates when they go to dentists that are within a given list. They can only choose their dentists from this list.

However, the difference is in the form of payment. In an EPO dental plan, the plan only pays for accomplished dental services, and does not pay for dental services in advance the way an HMO dental plan does. In an HMO plan, the insurance provider already pays all the dentists for all the plan members in a monthly basis.

3. Coverage of an EPO health plan

EPO health care plans provide ample coverage though there are certain restrictions. One thing to keep in mind is that customers can only be entitled to discounts when the policyholders go to dentists included in the plan. If they go to a dentist who is not a member of the plan, they will not avail of discounts. The only times when a policyholder can get discounts for services not provided by a dental professional in the plan is when there are emergency services, but these are very rare.

You should also be aware of the restrictions you will face under EPO health care plans. These restrictions may differ from one EPO provider to another, so it is important to clarify this with your provider. However, there are some common restrictions you will most likely encounter. First, most EPO dental health care plans do not cover specialized dental services since these are more expensive than regular dental procedures. Aside from that, experimental and cosmetic dental services are not included in most plans.

Given the restrictions in the coverage of EPO health plans, you should make sure to choose a plan that provides the best coverage.

4. How to claim from an EPO

You should also remember that you need to make a claim for your dental service. Either the dentist of the policyholder should make the claim.

In an EPO plan, it is important to submit claims in a timely way so that your dentist will get prompt payments. Some dentists choose to make the claims themselves to make sure they get the full payments they charge, but some dentists, on the other hand, prefer not to be part of EPO plans because they are often required to make reductions in the regular costs that they charge to members of the EPO plans. Thus, some dentists, especially those who no longer need the extra clientele boost, choose to forego memberships in EPO networks.

Where to Buy EPO Health Care Plans

EPO health care plans are widely available from insurance companies and health care companies. Joining these plans do not usually take much effort, but you may need to go through a formal procedure just like in other health and dental insurance plans.

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