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What Is PPO Dental Insurance?

Guest post by: John Clark

Article Overview: A Preferred Provider Organization dental plan is commonly referred to as a PPO Dental Plan. Many large health insurance companies, as well as free-standing dental insurance companies, offer PPO dental insurance plans. A person enrolls in a dental PPO and receives dental care through the insurance plan, just like a health insurance plan.

What Is PPO Dental Insurance?

A Preferred Provider Organization dental plan is commonly referred to as a PPO Dental Plan. Many large health insurance companies, as well as free-standing dental insurance companies, offer PPO dental insurance plans. A person enrolls in a dental PPO and receives dental care through the insurance plan, just like a health insurance plan. Dental PPO Description

A dental PPO plan is considered a managed care plan. An insurance company will recruit local dentists and dental specialists and contract with them to be a part of a network of participating dental providers. Individuals who join the dental PPO and pay the monthly premiums can then seek dental care from one of the participating providers.

A dental PPO saves insured individuals money on dental care because the insurance company that contracts with dental providers negotiates reimbursement (payment) levels. The individual then can access the dental provider and pay a fixed amount called a copayment for services received. This can mean substantial cost savings for care, even considering the monthly premium the individual paid the insurance company to have the coverage.

If the insured individual decides to see a dental provider that is not a part of the participating preferred provider list, they will pay a significantly higher portion of the dental bill. There is freedom of choice with a dental PPO, but with that freedom come higher out-of-pocket financial responsibility.

Dental Provider Credentialing

It is important to note that the insurance company will have a strict dental provider credentialing process that ensures the providers are licensed, high quality dentists and dental specialists. The credentialing process will check current dental state licenses, education, malpractice insurance, certification to dispense drugs, anesthesia permits, Medicare and Medicaid standing, and any history of malpractice. Further, the insurance company reviews any criminal convictions, child abuse allegations, substance abuse history, and sexual misconduct allegations.

After the initial credentialing review, dental providers are reviewed at designated intervals to ensure that they remain in good standing with state licensing boards. Most insurance companies also have peer review committees that monitor and review dental practices and conduct.

An insured individual can feel comfortable that dental providers participating in the dental PPO have undergone strict review and are quality, licensed providers.

Covered Services

Dental PPO's provide preventive dental care to the insured individual for substantially reduced payments. These preventive services include oral examinations, cleanings, sealants, fillings, and x-rays. Other covered benefits will include root canals, periodontics (therapy of the gums), crowns, dentures, extractions, and oral surgery.

Copayments for care can be as low as $50 for preventive services. For more complicated dental care such as root canals and dentures, the copayments can be higher and often will be a percentage of the total bill. It is not uncommon that an individual will be responsible for paying fifty percent of the total bill for a service they receive. This still equates to a significant cost savings for the individual receiving dental care.

Advantages of Dental PPO's

Too often people neglect to practice good dental care simply because of the cost. But not taking care of the teeth can lead to medical problems as bacteria grow in the mouth and gets into the blood stream causing health problems.

• Dental PPO insurance coverage eliminates the financial burden of seeking appropriate dental care.

• Selecting a good provider is made easier since the insurance company has already credentialed all the participating dental providers. An individual should still do their homework to ensure that the dental provider will meet their personal needs.

• Dental PPO's will save the individual the paperwork hassle of filing claims and waiting for reimbursement.

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Article Tags: dental insurance companies, health insurance, health insurance companies, health insurance plan, insurance, preferred provider organization
Referred by: http://www.franchisefix.com/



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