Dental Insurance 101:
What is PPO?
(Preferred Provider Organization) PPO is the most common form of insurance. When you sign up for a PPO insurance plan, you pay a monthly premium, and in exchange, your provider covers part of your treatments when you go to the dentist. With most plans, the highest amount of coverage applies to preventative services. While your insurance plan likely will not follow this verbatim, most modern PPO policies tend to have a benefits structure that looks like this:
- Preventative treatments (checkups, cleanings, x-rays, etc.) receive 80-100% coverage
- Basic restorative treatments (fillings, extractions, etc.) receive 60-80% coverage
- Major Restorative treatments (crowns, bridges, dentures, etc.) receive 40%-50% coverage
- Cosmetic treatments (whitening, veneers, etc.) receive, generally, NO coverage because they are elective procedures
The best way to maximize your policy is simply to attend your two routine appointments each year. YOU WILL USUALLY SPEND LITTLE TO NOTHING OUT OF POCKET AT THESE VISITS, REGARDLESS IF YOUR DENTIST IS IN-NETWORK OR OUT-OF-NETWORK.
We ask that patients understand that due to the way insurance plans are structured, there will be limitations as to how much of our work is covered under their plan. We cannot allow their limitations to prevent us from properly administering necessary and quality treatment.
What is an in-network versus out-of-network dentist?
Providers can elect to either be in-network or out-of-network with the PPO dental insurance company.
- If the dentist is in-network with your PPO provider, then the dentist has agreed to a set fee schedule. This simply means we have a contract with that insurance company and have agreed to abide by those fees, in return, for being on their national list.
- If the dentist is an out-of-network provider, then they do NOT have a contract with the insurance company. However, most services are still covered at the same estimated percentages, with preventative treatments (checkups, cleanings, x-rays, etc.) usually being covered at 80-100%, so you will usually have little to no out of pocket.
Our office policy:
Many of our patients have dental insurance and most of the policies differ in benefits. The cost of your treatment plan is based on your individualized needs. It is our goal to streamline the insurance billing process for our patients. Therefore, our policy is as follows:
Prior to any treatment, we will provide you detailed information regarding your care, treatment sequence options, and financial investment. Payment for services is collected at the time of treatment. As a courtesy to our patients, we will submit insurance claims and necessary supporting paperwork on your behalf.
Remember that your insurance policy is an agreement between you and your insurance company, so you are therefore responsible for payment of your treatment, such as co-payment or the non-covered balance. This can be paid by cash or most major credit cards.
We also participate in the CareCredit program. CareCredit offers a comprehensive range of payment plan options for various treatment procedures. For more information, please contact us or visit the CareCredit program online at www.carecredit.com.
**We accept all major PPO dental insurances as an “out of network provider”, except for the ones where we have contracted to be in-network with (Cigna, Delta Dental). Since these can change, we encourage you to call us at (469)289-5959 with your questions.**