What is a PPO Dental Plan And How Does It Work?
PPO stands for Preferred Provider Organization. In a PPO, members enjoy the freedom to see any dentist from the network of participating providers, including specialists, without a referral. With a PPO you will receive the highest level of benefits when you seek care from a contracted network dentist. Your out of pocket expense will be significantly less if you access care from “participating” providers. In addition, you do not have to worry about any claim forms or filing of claims yourself.
Do I Need to Select a Primary Care Dentist?
No – you do not have to select a primary care dentist, there are no referrals, and you can go to any dentist of your choice! Of course when you stay in network, you’ll get the highest level of benefits for the lowest cost and you’ll avoid having to complete claim forms, keeping primary care dentists a convenient choice.
Do I Need a Referral to See a Specialist? No – you do not need a referral whether you are using in-network dental providers (commonly referred to as “Participating” or “Par Providers”) or you are using out-of-network dental providers (commonly referred to as “Non-Participating” or “Non-Par Providers”). You will never need a referral.
Will I Save Money if I Visit a Participating Network Dentist?
Yes! The Dental PPO network dentists have agreed to offer their services to our members at a discount (usually between 15% – 30%). This means you will have lower out-of-pocket costs when you visit dentists in the network. It is the same type of advantage as selecting a primary care dentist.
If your dentist is outside the network, you may be “billed” for charges in excess of the “Reasonable and Customary” (R&C) limit. This means that if your out-of-network dentist’s fees are higher than the allowed R&C amount (which is set by a national database that all insurance companies use), then YOU have to pay for the excess.