A PPO is a dental preferred provider organization type of a dental plan. PPO plans offer a network feature and dentist who work with this plan agree to accept contracted fees in full rather than their usual and customary fees. A PPO plan doesn’t require you to choose a primary care dentist. Instead, you can choose any dentist in or out of network, though your cost will be higher with an out of network dentist.
When you choose a PPO plan you will know up front the most you’re likely to pay, which will help you to keep your out of pocket cost down. You typically pay a certain percentage of the reduced rate called the copay and the plan pays the rest. The percentage varies by the type of coverage such as preventive, basic, major services, etc. For example, preventive services may be covered at 80% and your out of pocket would be 20%, while crowns may be covered at 50%.
PPO’s usually require you to meet a deductible and have an annual maximum amount of coverage for a calendar year that don’t carry over. There may be waiting periods for certain procedures and they vary based on how long you have had the insurance plan. Some PPO’s may have downgrades, missing tooth clauses, as well as tooth replacement clauses.
There are several PPO dental plans such as Delta Dental, Cigna, BCBS, Met Life, and Aetna just to name a few. PPO insurance plans offer more covered procedures overall and lower copays and they do allow you to visit the dentist of your choice, even if they are not in network.
I hope this Tooth Talk has helped to explain what a PPO dental plan is and next week I will discuss what an HMO dental plan is. Please email [email protected] or call (615) 445-8700 if you have any questions, Integrity Dental Care, PLLC