MANAGED CARE (DHMO)
Based on the principle that it is less expenseive to prevent dental disease than it is to treat dental disease, Managed Care Dental Plans, or Dental HMOs, offer comprehensive coverage at greatly reduced costs. Members receive the dental treatment they need and groups receive stable preimums - everyone benefits.
Managed Care Plans include more coverage at lower costs. Many services are covered in full, including diagnostic and preventive treatment. Other services are covered with patient copayments that are fraction of usual and customary dental fees. In these plans, services are provided through a network of dentists and specialists who are motivated to bring patients to a state of optimal oral health as quickly as possible and maintain this healthy condition.
With a Managed Care Plan, you have the satisfaction of knowing you are receiving excellent, affordable dental care, supported by extensive Quality Assurance and Utilizations Review Programs.
PREFERRED PROVIDER ORGANIZATION (PPO)
In PPO plans, members are not limited to participating providers and are covered for services rendered by an licensed dentist - anywhere. Fee-for-Service plans typically have deductibles, maximums, and allowances can be based either on fixed schedule or a percentage of usual and customary fees. Patients are responsible for paying the difference between the plan's benefit and the dentist's fee.
As an additional feature, members in Fee-for-Service plans can receive treatment from dentists who participate in Healthplex's Preferred Provider Organization (PPO). These fully credentialed providers have agreed to accept reduced fees from patients in our reimbursement plans. Our PPO network includes general dentists as well as specialists in Endodontics, Periodontics, Pedodontics, Oral Surgery and Orthodontics. Participating dentists are contracted directly with Healthplex in New York and New Jersey, and are also available in every other state through an affiliate.
ADMINISTRATIVE SERVICE ONLY (ASO)
Our Administrative Services Only (ASO) plans provide you with expert guidance and superior management. We can help you design and implement a customized program with a wide range of features. And, because dental is our only business, we will pay attention to the details and follow your plan specifications to the letter. When you combine our skills with current technology, the result is quality service at a reduced cost. Your enrollees will receive the exact benefits to which they are entitled and you will benefit from the savings!
Administrative Services include:
- Plan development and design
- Actuarial determinations and recommendations
- Correspondence with providers
- Predetermination of claims
- Claims adjudication (including internal review)
- Explanation of Benefits (EOB) statements and check
- Claim history maintenance
- Utilization review and reports by procedure, patient and/or provider
- COBRA benefit processing
- Friendly and knowledgeable Customer Service Department