Dental insurance is crucial to maintain a healthy smile and achieve overall dental health. While most people are insured through their employer, self-employed and unemployed can sign up for personal dental insurance. However, it is essential to understand what is covered on different dental plans to get the best coverage that meets your needs.

The preferred provider organization plan (PPO) is one of the most popular dental insurance companies. This guide highlights how the dental PPO plan works and its importance.

How PPO Dental Insurance Works

A PPO plan is a type of dental insurance that allows patients to choose multiple dentists from different professionals who accept a contracted service rate. It means the dentists charge a discounted rate, which is paid in full than regular fees. Patients visiting a PPO dentist are responsible for a part of the discounted rate, whereas the insurer settles the balance.

The amount the patient pays is often lower based on the procedure than paying the full amount for the dental service offered. Therefore, PPO dental insurance plans provide the cheapest out-of-pocket options. However, it is essential to understand the dentists available on the network before choosing your preferred PPO plan. This allows you to work with a comfortable or convenient dentist to meet your family’s needs.

What Does PPO Dental Insurance Cover?

Every dental PPO plan classifies basic and major procedures differently based on several factors. When seeking a specific dental service, it is crucial to check your plan despite PPO having minimal differences in what is covered and its costs. Below is a breakdown of what PPO dental insurance covers;

Preventative Care services

  • Annual or semi-annual visits for cleanings
  • Sealants
  • Fluoride treatments
  • X-rays

Basic Procedures with Discounted Co-Insurance Fee

  • Fillings
  • Treatment for gum disease
  • Tooth extractions
  • Root canals

Major procedures with Discounted Co-Insurance Fee

  • Bridges
  • Inlays
  • Crowns
  • Dentures
  • Root canals

Several dental insurances, like PPO plans, don’t cover cosmetic procedures such as teeth whitening, veneers, shaping, and gum contouring. This is because insurers focus on medically necessary procedures rather than treatments to improve the look. In some cases, some plans can cover braces under certain conditions.

PPO Dental Plans Give Patients More Flexibility

PPO plan networks provide numerous professionals to choose from, whether general dentists or specialists. It lets patients choose their preferred dentist within the extensive provider network. Seeing a specialist also takes a shorter period while being free to choose whichever primary care dentist without any penalties. In addition, PPO dental plans allow you to switch between dentists within the network anytime without reason or by calling the insurer for approval.

While PPO plans have limits when choosing a dentist outside the network, it provides the flexibility to work with other dental specialists. However, visiting a dentist outside the network will result in higher out-of-pocket expenses for selected treatments not contracted with the insurer at a lower rate. Patients can see professionals and submit claims to their insurance company after treatment.

Benefits of PPO Dental Plans

With several insurance providers, dental PPO plans can come in handy and be more beneficial than other renowned insurers. Some of the overall advantages of using PPO for dental care include the following;

  • Visit any dentist: PPO plans allow patients to get care from any dentist, whether in the network or outside. However, it is important to understand the additional costs of visiting dentists outside the network.
  • Flexibility: PPO insurance plans have no specific dentist for patients to visit, allowing them to choose any dentist within the network. If you don’t like a specific dentist or prefer your choice, you can choose any other within or outside the network.
  • No referrals: Signing up for a PPO dental plan means getting the freedom to choose whichever dentist you prefer without being referred to a dentist to get treatment.
  • Cost-saving: PPO plans allow patients to acquire dental procedures at discounted costs, saving more depending on the care provided. Besides, it is easier to know the procedure costs upfront.

PPO Vs. DHMO Vs. Direct Reimbursement

Preferred Provider Organization (PPO), Dental Health Maintenance Organization, and direct reimbursement are the three major dental insurance plan types for patients. Each plan accompanies its pros and cons depending on covered services and cost. 

Preferred Provider Organization

A dental PPO plan allows patients to choose a dentist within an extensive network with the option of choosing dentists outside the preferred list at extra cost. These dentists have contracts with the insurer to provide discounted services. Patients can choose dentists not preferred by the insurance provider depending on reasons such as preferences.

Dental Health Maintenance Organization

A DHMO plan, commonly called HMO, contracts with dentists to settle a fixed amount per patient or family insured with the company. Whether they visit the dentist or get treatment, the amount settled allows them to receive dental care without paying the dentist for selected treatments. Generally, this plan helps reduce patient treatment costs but limits the number of patients you can visit.

Direct Reimbursement

Direct reimbursement involves the insurance company settling the total amount the patient spends on the dental care received. The primary benefit of direct reimbursement is that patients can choose a dentist because dentists aren’t contracted. However, the patient has to settle the payment with the dentist upfront and then claim the settlement from the insurance company. Dentists often allow payment plans or financing solutions for patients unable to pay upfront or facing hardships.

How PPO and DHMO Dental Plans Compare

DHMO and PPO dental plans differ in cost significantly, with DHMO plans lacking deductibles and annual max payments. Also, DHMO provides discounted dental services to patients when they receive treatments within the network. However, DHMO plans to limit the number of dentists patients can visit, meaning the network of dentists providing lower-cost dental care is smaller than PPO.

Bottom Line

With different types of insured dental care, a dental PPO plan can be helpful, especially for patients looking for numerous dental works. This is because you can seek more dental procedures at a reduced cost after reaching the plan’s annual maximum spent. Above is a guide that provides insights into the importance of a PPO dental plan.

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