What PPO Dental Insurance pays.
There are several types of dental insurance. This post will help explain how PPO (Preferred Provider Organization) Dental insurance works. Like medical PPO insurance, you can use in-network and out-of-network providers. The in-network dentists have agreed to accept the maximum allowable fee provided by the plan. However, if you go out-of-network the dentist can charge you the difference between what the plan will pay, the maximum allowable fee the plan will pay, and what the dentist may charge.
Example:
The plan will pay 70% of the maximum allowable fee:
In-network dentist:
A dentist can only charge the agreed amount of $900
The plan will pay a maximum allowable fee for a crown: $900
The plan will pay 70% of in-network dentists: $900 X .70 = $630
You will pay the balance which is: $900 – $630 = $270
Out-of-network dentist:
A dentist can charge any amount. An example: $1,200
The plan will pay a maximum allowable fee for a crown: $900
The plan will pay 70% of in-network dentists: $900 X .70 = $630
You will pay the balance which is: $1,200 – $630 = $570
Most dental PPO plans have a maximum annual payment limit for each insured person, which can typically be as low as $500 or as high as $10,000. However, there are plans with no maximum annual payment limit.
Conclusion:
When you are looking for a dental PPO plan, you should consider in-network dentists to ensure you get the best bang for your buck. It is also very important to understand what is covered and the maximum dollar amount the plan will pay each person each year.
If you would like to compare dental plans in your area and live in one of the following states, tap on the state: Arizona, California, Nevada, Oregon, or Washington, or click on Answer to Questions Dental Insurance. For a no cost no obligation conversation about your needs.
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