Wellness

What is a PPO?

Small girl smiling and pointing to teeth while sitting in a dentists chair.

Dental insurance gives people peace of mind. They know their coverage helps them protect their smile by keeping their teeth and gums healthy. Dental plans are designed with different types of coverage. A key plan element is access to a nationwide network of participating dentists and specialists. One popular network design is the Participating Provider Organization, known as a PPO. Review four factors that answer the question, “What is a PPO?”

  1. Offers a large network of dental providers

    A PPO is a group of dentists and specialists who have agreed to participate in the network. Many people have a preferred dentist and don’t want to find a new one. With a PPO, members can see any licensed dental provider, even if they don’t participate in the network. But members receive the most cost savings if they see an in-network provider. However, there’s a good chance the preferred provider is in the network. But what if they’re not? Then the patient can request it through the insurance company and see if the provider accepts.

    Learn more about common dental terms, including PPO, which also can stand for Preferred Provider Organization.

    A PPO usually has an extensive network of dentists. Many participate in the plan to increase the number of patients they serve. When reviewing dental plans, see if your dentist is in-network. What is the best way? See the insurance company’s Find a Provider online directory. And, ask a few questions to find out about the number of providers in the PPO and how they’re counted. For example, if three dentists work together and have two offices, the network shouldn’t count them as six providers.

    If you’ve recently moved or are looking for a new dentist, here are five tips for finding a dentist that fits your needs.

  1. Members spend less on dental care

    Dentists and specialists in a PPO network agree to provide services at discounted rates to members of the dental insurance plan. The rates they charge can be anywhere from 25% to 50% less than the provider’s usual and customary rates. Plan members may pay a portion of the discounted price with the plan covering the rest. What does this mean? It could be in the form of a deductible. Or, it could be reflected in the percentage of coverage, such as 100%, 80% or 50% for different procedures. In addition, PPO providers may offer discounted rates on non-covered dental services as approved by state law.

    While plan members can see any dentist, if the provider is not in the network, they’ll pay regular rates. What’s important to remember is that in-network providers charge plan members reduced rates. But either way, the PPO plan will help cover costs, unless there are no out-of-network benefits. Dental plans focus on Preventive, or Type 1 care, to prevent painful decay. Preventive care includes a dental exam, bitewing X-rays and professional cleaning. The visit also may include space maintainers, and fluoride and sealants for children.

  1. Helps manage dental claims

    Dental plan members who visit an in-network dentist or specialist do not submit their claims. The network provider does that for them. Also, claims usually are filed electronically, so they are processed more quickly. Sometimes out-of-network dentists will file member claims as a courtesy. What patients don’t like are unexpected expenses. So they like having their claims paid as soon as possible.

  1. Know dental costs in advance

    Preventive/Type 1 dental checkups and professional cleanings typically are covered at 100% by dental plans, including PPO plans. Basic/Type 2 procedures may be covered at 80% and Major/Type 3 procedures at 50%. Before scheduling a dental procedure, ask the dentist what amount is covered by the plan. Dental providers also can submit a pre-treatment estimate to the insurance company to find out.Learn more by reading this blog on how to estimate dental costs.

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