DHMO plans work very differently from PPO dental plans in that the insurance company is rarely involved in payment for treatment. There are no claim forms to mail in and no payment to be received from services rendered. In addition, the patient is assigned to a single office with no flexibility to keep their existing dentist.
Unlike a PPO dental insurance plan, there is no maximum benefit amount because the insurance company is not making payments to the dental office for individual procedures performed. Instead, the insurance company sends the dental office a payment (usually between $3 and $10 per patient per month) with the patient responsible for the remainder of the treatment costs. The cost of premiums is lower because the insurance company is not paying out money on claims. This type of insurance can be very affordable for patients with limited dental needs.
There are relatively few exclusions with a DHMO plan as the insurance company isn't paying out claims. The only major exclusions are that few general dentists accept DHMO plans and that even fewer dental specialists (such as oral surgeons and orthodontists) accept DHMO plans.
- Low cost for monthly premiums
- Few exclusions
- Significantly higher out of pocket treatment costs than a PPO
- You are assigned to a single dental office that may or may not be close to your home or work
- Difficulty finding a dental specialist in the DHMO network