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“My dentist told me to find a PPO dental plan.” You would think that all you need to do is find a PPO dental plan and everything will be fine. The universe will be in perfect alignment. Sorry to bust your bubble. Let me translate this for you. What your dentist is telling you is the following: I am not a network provider for every PPO dental plan. As a matter of fact, I might not be a network provider for any dental plan. If I am in the plan's network, I will give you a discount on all services and they hold my feet to the fire as to what I can charge you. If I am not in the network, I will charge what I damn please and submit your claim for you. The insurance company will pay a rate that 90% of the dentists in this area charge - but I might not be one of them. The lesson here is to try and find a provider that is in the plan's network. Otherwise, try to find out how much extra they are going to charge you. What is a PPO Dental Insurance Plan? A PPO consists of a network of dentists who have agreed upon a pre-negotiated, discounted price for their services. Depending upon what procedure is being performed (filling, cleaning, etc.), you will only have to pay this predetermined discounted rate. The plan will pay for a percentage of this discounted rate and you will pay the rest. A typical plan might look something like this:
It all depends on the plan. Plus there is a cap on the total amount the insurance company will pay per person per year. This varies from $750 to $1500 per annum, per person. The dentist does not have to honor the PPO rates after you use up your annual limit of coverage. Although, if they are that greedy and decided to charge you full price and drop the discount, you should find a new dentist. I find that type of behavior to be despicable.. Clearly, if you need many thousands of dollars worth of dental work in one year, you are going to pay a good portion of it from your own pocket. If that is the case, you want to make sure you are receiving the PPO rate for the entire treatment plan. Or, you can use one of our indemnity plans with a ppo-like network. They usually cover everything. More about that in a minute. What Does a PPO Dental Plan Cover? The services for most plans are divided up into three categories:
Most dental PPO plans do not cover major services until you have been on the plan for at least 12 months. Although, we are now offering a PPO plan that will cover a lot of major services with no waiting period and only a 6 month wait for crowns and dentures. Should I Buy a PPO Dental Plan? PPO dental insurance is the most requested type of dental insurance.
PPO Style Plans An indemnity plan is a plan that pays out fixed amounts for various procedures. We have a separate page for this type of plan. Most of our PPO dental plans pay a percentage of costs. For example, a PPO might first discount a crown to $500 and then pay half of it. Leaving you a $250 bill. Actually, that is not bad considering that many people pay $700 to $900 for a crown. An indemnity plan pays you or your dentist fixed amounts for various procedures. So, the plan might pay you $250 for a crown and so forth. If you use an indemnity plan with a good network (looks just like the PPO network), you end up paying the same. Plus, if the dentist is not in the network or you want to negotiate on your own, you still get paid out the fixed indemnity amount. For quotes on any of our dental plans, go to our dental plan quotes page now. |