Dental Insurance Plans: Preferred Provider Organization (PPO)

Among the many kinds of dental insurance plans, one very common type of policy is a Preferred Provider Organization or PPO policy. A dental PPO works the same as a major medical PPO in many ways. Learning about this kind of policy can help policyholders use it correctly and benefit from its particular contract details.

Preferred Provider Organization Defined

The dental Preferred Provider Organization is one of several kinds of plans that focuses on saving costs by choosing participating providers. This kind of detail is also part of many health maintenance organization or HMO plans, but is a major aspect of a Preferred Provider Organization. In a PPO setup, patients can often only get available coverage by going to a specific set of dental offices listed as preferred providers.

The reason that health insurance companies set up dental PPOs is that they can save money through partnering with specific dentists and dental practices. What happens is that the insurance company has a contractual agreement with the provider for a fee schedule. That’s why health insurance companies can offer the patient lower costs when they go to the offices that are included in these specific contracts.

Who Benefits from a Preferred Provider Organization?

Patients who benefit from a PPO the most are those who have no trouble selecting specific providers who have agreements with their insurance companies. For example, a family who has been going to a regular “family dentist” for years knows that their insurance company has a contract with that dentist if they are using a PPO. They don’t have to worry as much about some of the restrictions and limitations of their plan.

On the other hand, those who require more specialized dental services may not benefit as much from a PPO dental plan. As the required services get more complex, it often becomes harder to stay within the provider network or set of participating providers. When a family’s dental care is limited to regular cleanings and an occasional cavity, they can always use the same provider, but when dental care starts to include orthodontics, treatment for gum disease, or visits to specialists for other dental problems, the patients may find some costs denied by the PPO if they did not get the correct referrals or keep their visits within network.

Locating Dental PPOs

A wide variety of major dental insurance companies offer Preferred Provider Organization plans. Big dental firms from Guardian and UnitedHealth to other state-specific insurers have their own PPO plans with their own sets of participating providers. Patients can ask a specific dentists office what different insurance companies the office may participate with in order to match up a provider with a plan. Another resource for locating insurance plans is a state insurance agency, as health and dental insurance systems are different in every U.S. state.

Think about the above when selecting an HMO, a PPO or other dental plan to see if your family can benefit the most from less limited policies or more restricted, cost-saving plans.

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