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What is PPO Dental Insurance?
A preferred provider organization (PPO) is a type of dental insurance plan in which individuals select their dentist from a network of preferred dental providers who agree to provide dental care to individuals at reduced rates.
PPO dental plans restrict costs. A PPO plan provides the opportunity to reduce out-of-pocket costs by using an in-network provider. The participating dentists agree to charge less than their usual fees, therefore providing more savings for consumers.
Patients who participate in PPO dental plans select a dentist from among the group participating in the PPO, and they are assured in advance of the maximum cost of their dental treatment.
However, PPO dental plans also restrict services. The types of dental treatment available to the patient and the amount of time participating dentists are willing to invest in any given procedure are typically subject to limitations.
PPOs do include a calendar year maximum, a deductible , and waiting periods for certain procedures. In addition, while some (not all) PPO dental plan providers allow patients the freedom to select an out-of-network dentist, patients who do so also have higher out of pocket costs.
PPO Dental Plans and the Patient: What to Consider
Patients considering participating in a PPO dental plan should first consider several variables.
Those who have a dentist that is not in the plan network should determine if the discount is substantial enough to induce them to change to a dentist that participates in a particular PPO dental plan. Equally important, patients should examine in detail any restrictions on the types of treatment that participating PPO dentists are willing to provide.
If a PPO subscriber chooses to see a dentist who is not part of the dental network, some PPO plans will pay based on UCR (usual, customary and reasonable fees), but most out-of-network benefits are paid based on MAC fees (the maximum allowable charge for the plan). Consumers may be responsible for the difference between the MAC and the actual dental charge from a non-participating provider
Customers who have used their annual maximum or have exceeded the number of cleanings they can get each year are still subject to pre-negotiated prices when they see an in-network dentist. This can mean big savings when patients receive additional services, because they are not subject to the full costs dentists would charge patients without insurance.
Finally, any provisions in the PPO dental plan relating to emergency dental care should be reviewed carefully. So should provisions concerning dental treatment that may be needed when traveling away from home.
Summary of PPO Challenges and Strengths
If these and other important stipulations of the PPO dental plan meet the needs of the patient, a PPO plan may be a sensible option.
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