What is an Open Access Dental Network?

By Brooke Ellis on Sep 9, 2016 @ 11:35 AM

If you've ever shopped for dental insurance, you will know how much information is thrown your way. There are enrollment periods, deductibles, copayments, and allowable charges. One of the most essential pieces to consider is a plan's provider network and access criteria. Network and access are critical components of dental HMO (DHMO) plans.

DHMO plans can get a bad rap due to restrictions on the network and limits on the providers you can visit. However, "open access" networks are changing that. This variation on the DHMO plan model provides more flexibility to members so they can get dental care when needed.

Read more about open-access DHMO plans and see if they can benefit you.

Key Takeaways:

Typical dental HMO plans have restrictions on the network and limits on the providers you can visit.
Open-access DHMO plans to provide more flexibility to members so they can get dental care when needed.
DHMO plans usually require pre-selection or assignment to a specific primary care dentist.
Open-access DHMO plans eliminate the assignment pain points and account for individual needs.
When choosing a dental plan network, you should look at all aspects, including costs, covered procedures, and network access.

How does a DHMO plan usually work?

As a typical DHMO plan member, you must pre-select or be assigned to a specific primary care dentist. They oversee all of your dental care. If you want to request a different primary care dentist, you must call your insurance company. You may also have to wait a certain amount of time before making a change.

Even when your transfer to a new primary dentist is complete, some offices might wait to schedule your appointment. Dentists on a DHMO network receive a monthly list or roster from your insurance company. This often results in frustrating, long appointment wait times, which could be better when you need to see your dentist.

Are there any advantages to a standard DHMO plan?

Typically, DHMO plans are known to have lower monthly premiums and copays than other dental insurance plans. However, it's important to note that DHMO plans often have a limited network of dentists. Hence, it's essential to consider your individual needs and preferences when looking at dental plans.

What is an open-access DHMO network?

You will be relieved to know that some DHMO plans have an open-access network. These plans maintain some of the benefits of a DHMO plan, like lower monthly premiums and predictable out-of-pocket costs.

Additionally, open-access DHMO plans eliminate pain points and account for individual needs. Typical features of an open-access DHMO plan include:

There is no waiting period for coverage to begin
No limit on the number of visits or services you can receive in a year
Access to any in-network dentist you like with no selection or assignment requirements
Switching providers at any time without calling your insurance company
No waiting for rosters or lists to receive the necessary dental care.
A network of dentists who have agreed to accept discounted fees for their services

Now, more than ever, convenience is critical. Open access plans fit into the fast-moving world we live in today.

How to choose a dental plan network

If you are choosing a DHMO plan, look closely at all aspects. Of course, you'll be looking at costs and covered procedures. And as we've discussed here, be sure to look at network access.

Here are some factors to consider when picking benefits and a dental plan network:

Check your dentist's affiliation: If you already have a dentist, ensure your dental plan includes them in the network.
Consider the coverage: A dental plan should cover standard services like cleanings, X-rays, and dental procedures.
Evaluate the cost: Consider the monthly premium, deductible, coinsurance, and copayments associated with the plan. The costs should fit your budget and provide value for money.
Read the fine print: Carefully review the terms and conditions of the plan, including any exclusions or limitations. Make sure that you understand what is covered and what is not.

Considering these factors, you can choose a dental plan network that meets your needs and helps you maintain good oral health.

Get your free copy of our detailed guide for more tips on open-access DHMO networks.