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Agent Straight-Talk




Dean George is the Marketing Specialist and Content Creator for Dental Insurance
Store and its social media channels. He is a regular contributor to Agent Straight Talk, the
only consumer blog explaining the ins, outs and in-betweens of dental insurance and
discount dental plans. READ MORE

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A Father to Son Heart to Heart About PPOs

May 20, 2014

By Dean George

Patrick PPO knew something was wrong as soon as he got home from work and saw his son Pat sitting on the front porch.

Walking up to his son, he set down his laptop bag, loosened his tie and sat down next to Pat. “Something wrong, son?” Sniffing, Pat wiped his sleeve across his nose and shrugged. “Nothin’s wrong, Dad. I’m okay.”

Eyeing his boy closer, Patrick noticed big tears welling in Pat's eyes. Putting an arm around him, he said, “C’mon Pat, what’s wrong. Tell Dad what’s bothering you.”

Choking back a sob, Pat sniffled again before swallowing hard and blurting out, “The HMO guys at school won’t quit teasing me!” “Teasing you? What are they teasing you about?” “Just stuff,” Pat said, averting his father’s eyes. “What kind of stuff?” his Dad asked softly.

Sighing, Pat said, “The HMO guys were ragging on me because of our deductibles and waiting periods. And they said that PPOs are rip-offs because they limit how much money they’ll pay every year.”

Sighing, his Dad blew out an exasperated snort. “Oh, they did, did they?” Pat solemnly nodded his head yes. Feeling his blood pressure begin to rise, Patrick slowly counted to 10 before again addressing his son.

“Look, Pat. I know how you feel, son. When HMO’s first moved into the insurance neighborhood, everyone was kind of excited about them. They were new and different, and people liked the idea of paying less for their dental coverage.” Pausing, Patrick looked thoughtfully at his son before continuing.

“But you know what? Some people weren’t so excited about them once they learned that seeing their favorite dentist wasn’t always doable. And other people that needed serious oral surgery weren’t happy at all when they realized that they couldn’t schedule their own appointment with an endodontic or periodontal specialist without clearing it with their primary care dentist first.”

“But we let people see who they want, don’t we Dad?”

“Yes we do,” his Dad said. “Our PPO family let members go in network or out of network for any of their treatment. Look, do you remember when we were on vacation two years ago and your sister couldn’t sleep because of a toothache?”

Pat nods yes, adding, “She cried all night long and kept us all up.” “That’s right,” his Dad says nodding back. “And do you remember we were able to get her into a dentist just a few miles from where we were staying? And we were able to get her tooth fixed early that morning and by lunchtime you and your sister were playing in the pool?”

“Yeah, I remember that. Whenever she smiled, she drooled in the pool until the Solarcaine wore off and she made a face like this,” Pat said, imitating what his sister looked like after leaving the dentist office.

“Uh, that was Novocain, not Solarcaine, son. Anyway, the point is because she wasn’t an HMO plan, we were able to find a dentist even though we were a long way from home. That’s because we have over 100,000 dentists in our PPO family.”

“But what about what the guys were saying about deductibles and waiting periods? Why do we have them if they don’t?” “Well,” his Dad said thoughtfully, “HMOs just use a different care model than PPOs do. For instance, HMOs look to control costs by micromanaging the care they offer through networks and what they compensate contracted dentists for procedures.”

“Huh?” Pat said perplexed, scrunching his face.

“What I mean, son, is that HMO’s look to take care of their members a little differently than PPOs do. PPOs provide our members more freedom over the dentists they see and what specialists they use. HMO’s are a little stricter because they don’t collect annual deductibles or require people to wait a few months for major treatments.”

“So you’re saying people with HMOs have less skin in the game than those using our PPO plans?”Pat asked his Dad. “Uh, that’s right,” his Dad said, scratching his head in wonderment at how fast his son seemed to be growing up.

“Is it true that HMOs don’t limit how much their plans pay for treatment every year?” Pat asked.

“It’s true that PPOs do have a cap on how much we pay per year, but most of our plans pay 80 to 100 percent for preventive and diagnostic treatments. And with no waiting periods,” he added. “The idea is we PPOs help people take care of the small things at little or no cost before they become bigger, more expensive problems. Make sense?” Patrick asked his son.

“Yeah, I think I understand,” Pat said slowly. “So you’re saying that just because our plans work a little differently, they’re still as important as a HMO plan. And we help people that need dental care – just like HMO’s do?” “Exactly,” his father says with a smile. “And not only that, but some of our PPO’s like Renaissance Dental even offer benefits that some HMOs don’t, like dental implants.”

“Wow! Wait till I tell the guys that we’ve got more dentists than they do and PPOs do things that HMOs don’t!” Pat says excitedly.

”Atta boy, son. You tell ‘em that!” his father says, clapping him on the back.

“Hey, Dad,” Pat says suddenly growing serious. “While we’re talking about stuff, can I ask you something else I’ve heard at school?” “Sure son, what is it? Ask me anything!”

“Well, where do baby dental plans come from? I mean, one of the HMO guys was saying…”

“Uh, oh,” Dad says, looking suddenly apprehensive. “Look Pat, it’s getting late. Wouldn’t this be a great night for pizza?! Tell you what; go tell your mother not to worry about supper tonight. While I’m out getting the pizza she can tell you all about where baby dental plans come from.”

We’re with Dad on this one. When it comes to baby dental plans, we’ll defer to others, but we know all about grown up and responsible PPOs, HMOs and discount dental plans that can save you money while keeping baby teeth and adult teeth in good chomping shape. You can to by clicking here.

Thanks for reading Agent Straight-Talk, and learn more about dental plans, oral hygiene, keeping teeth healthy, and a 1,001 things to do with dental floss by following us on Facebook, Twitter, Pinterest, Google+, and LinkedIn!  

Copyright 2014, Bloom Insurance Agency, LLC   

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