Purpose
Identify the patient's dental plan type to understand coverage and how to process care.
PPO (Preferred Provider Organization)
- Patient can see any dentist, but pays less if in-network
- Most flexibility — has out-of-network benefits too
- Most common plan type we see at BrandaCare
- Typical structure: deductible + % by category + annual max
HMO (Health Maintenance Organization)
- Requires patient to select a primary care dentist
- Does NOT allow out-of-network
- Generally fixed copays per service
BrandaCare policy: Almost NONE of our clients accept HMO. If an HMO comes in we notify the office — typically patient can't be seen UNLESS plan has out-of-network benefits.
Indemnity / Traditional
- Patient can see any dentist
- Insurance pays % of UCR (Usual, Customary & Reasonable)
- Less common today
DPP / Discount Plans
Dental Discount Plans (NOT insurance).
- Patient pays monthly fee to plan
- Receives discounts instead of coverage
- Examples: Careington, Aetna Dental Access
Stedi does NOT work: DPPs are not traditional payers. 270/276 calls don't work. Verify manually and process differently.
Medicaid
- Card: Typically issued by state (Florida: yellow)
- Or by contracted private insurer (Sunshine Health, Simply Healthcare, Humana Medical, etc)
- Limited adult coverage in many states
Medicare
- Original Medicare card: Red, white & blue paper card. 11-digit alphanumeric ID (e.g. 1EG4-TE5-MK72)
- Medicare Advantage: Plastic card from private insurer (Humana, UnitedHealthcare, Aetna, Wellcare)
- Dental traditionally limited — only oral surgeries related to other conditions
- Some Medicare Advantage plans include additional dental benefits
See TRN-INS-003 — Dental Coverage in Medicare (Florida 2026)
Next module
TRN-INS-002 — Coverage Structure (Max, Deductible, Copay, %)