Index | Dental Insurance | Preferred Provider Organizations (PPO)
Preferred Provider Organizations (PPO)
Dental Preferred Provider Insurance plans work with a group of dentists who belong to the network of providers. The network generally includes dentists, different types of dental care specialists and dental hospitals. When you apply to a dentist working under contract with the insurance company providing your coverage, you usually get substantial discounts and your overall dental care expenses are smaller. As long as you stay within the treatment and care network established by the dental PPO, you will pay either no charge at all or a fixed charge which is usually lower than the normal charge. Thus, the customers are offered financial incentives for choosing dentists from the PPO network.
If you want to obtain dental treatment from a specialist who is not on the list of preferred providers, you will most likely have to pay the full price for the services performed. Catering to the customers' needs in some cases insurance companies include in PPO plans a special provision according to which the policyholder may seek treatment from a non-participating dentist.
Being a Managed Care Plan, a PPO plan offers all the benefits shared by all Managed Care Plans, namely, one of the benefits of PPO plans is in the price. A dental PPO plan is normally not expensive, so you receive solid coverage without having to pay quite a fortune for it. In other words, it presents a combination of a good quality and a reasonable price. In financial terms, PPO plans usually require a low deductible or sometimes even no deductible at all.
What adds to the convenience of dental care is that PPO plans usually involve short waiting periods or sometimes no waiting periods at all. At the same time, it is important to bear in mind that with a PPO plan all types of dental treatment can be imposed a waiting period on, even preventive and basic care services.
The fundamental difference of PPO plans from DHMO plans is that the in-network providers are paid by the Preferred Provider Organization for the services performed but not per patient. It implies that the dentist is likely to offer you the full range of treatment you need. Besides, unlike a DHMO plan, a PPO plan does not make the insured person choose a primary care dentist and does not require an authorized referral to see a specialist. This plan procures an opportunity to choose any specialist working within the network of providers.
Most PPO plans include a provision according to which there is no balance billing when you use participating providers, i.e. the dentist will not charge you more than the plan's allowed amount for the performed dental treatment.
It is also convenient that with a PPO plan you do not have to think about paperwork or filing in claim forms. The dentist will do it for you. Your insurance company usually pays the dentist on receiving a claim from him/her. All you have to do is just show your insurance card with your insurance number when you come to the dentist for a visit.
One more advantage of PPO plans is the feature allowing you to receive in-network benefits even if you are outside the service area. Depending on your lifestyle this feature can make for choosing a PPO plan as the most appropriate to your needs.
Not only insurance companies offer plans of this type to individuals. Many companies offer PPO plans to their employees. Such plans are usually very cost-effective for the employees. If your employer offers you a PPO plan, he/she usually contributes to funding your insurance. As a result, you will pay less than if you were insured as an individual customer.
When it comes to the disadvantages of PPO plans, the major one is that you are bound to choose a dentist from the list. If you apply to a non-participating dentist, you will have to cover the dental care expenses out-of-pocket. It makes PPO plans restrictive in terms of getting benefits and in terms of the costs associated with the received benefits.
Another obstacle that may await you is that some insurance providers may offer coverage starting with $ 1,000 regardless of the actual complexity of the services performed. Of course, such a provision makes dental plans of this type less affordable. What is more, most PPO plans require paying a deductible. Small as these deductibles are, they can turn into a financial burden if all the members of your family are covered by the plan. One more possible problem which policyholders with a PPO plan can meet is that dentists may refuse to accept eligible clients with certain types of PPO plans if they know that they will not be reimbursed for the services performed.
The conditions and provisions of PPO plans vary, but with all their advantages and disadvantages PPO plans present rather a good balance between affordability and the scope of coverage. As can be inferred from what is said above, PPO plans are beneficial to all the parties involved. Dentists get more clients to treat due to the referrals from the insurance company. In their turn, the clients insured through a particular dental insurance company are offered substantial discounts by in-network dentists.