PPO Benefits Explained These days, more and more dental offices are accepting assignment from Dental PPOs, but most patients do not understand their benefits. It is easier to blame the office processing these claims which previously would have been filed by the patients themselves, so lets get down to discussing what these PPOs actually are and what they do for you. A PPO is a preferred provider organization. It is a formal agreement between a participating dentist and the insurer as far as fees go ONLY. Dental offices do not have any “ins” with insurance companies to get them to pay faster. Dental offices are a third party. PPOs differ significantly from traditional indemnity insurance where a patient could seek care and use the insurance ANYWHERE and they paid a percentage of any dentists fees no matter how high or how low. These types of policies have largely disappeared and I cannot think of the last time I saw one. PPOs keep fees low for the patient AND for the insurance companies issuing them. PPOs still allow you to go anywhere, but they would much prefer that you go to a participating provider or stay in the network. Why is the network so important? Because the fees are generated by the insurance company issuing the insurance. PPO agreements with dentists limit fees to maximums set by the issuing PPO. Why is this so important? Because the PPO fees are 20 to 50% LESS than most dentists usual and customary fees. Thats not chump change! Those are real savings to the consumer and to the insurer. If you go somewhere out of network, your fees and the costs to the insurer are usually much higher than in network. Whats more is that when you have run out of insurance benefits, the services are still discounted so if you need four crowns, your insurance may run out after one and a half crowns but you still get the remaining 2 ½ crowns for the discounted rate. People often complain about how high dental fees are, but, as Ive said, the fees are now set by insurance companies, not the participating dental offices. Also, how those claims are handled is different from office to office. Some may collect the entire amount and have the PPO pay the benefit directly to the patient. Others, like mine, will make a best-effort estimate and charge the estimated patient responsibility and have the PPO pay us the benefit. Regardless, you will receive an Estimate of Benefits (EOB) from your PPO within a week or two of treatment which is usually a full two weeks before your dentist gets a copy. It will list: the amount charged which is the dentists UCR fee, the contracted maximum allowable fee as dictated by the PPO, the amount the PPO will pay, and the patients responsibility which is also known as a copayment. The dentists UCR fee is included so that you can see the difference and the amount you are saving over full fee. If you have any questions about your insurance benefits, please give us a call at (772) 464-7214.
Posted on: Sun, 11 May 2014 13:00:40 +0000
Trending Topics
Recently Viewed Topics
© 2015