5 Ways to Compare PPO Dental Network Plans

When choosing benefits, employers often primarily focus on medical coverage, spending less time scrutinizing dental plans as closely. While Participating Provider Organization (PPO) dental plans seem all the same, they can significantly vary once you dive into the details.

The structures and coverage levels of networks can differ, even though dentists might be affiliated with several dental carriers. Decisions based solely on cost risk can overlook critical differences, such as how carriers calculate payments and reimburse claims. Thoroughly reviewing the dental contract is essential to understanding the network design and determining whether the plan aligns with employees’ needs.

About PPO dental network design

When setting up a PPO network , dental insurance carriers contract with dental offices in each market and dentists agree to charge less than their regular rates. These discounts can vary depending on the dental offices in that market and the number willing to agree to the fees being offered by the carrier.

Generally, plan members using dentists in the network will incur out-of-pocket costs only for coinsurance or noncovered procedures, depending on their plan design. While employees with a PPO dental plan may visit any dentist, they could experience higher out-of-pocket costs with dentists outside the network.

Spotting PPO plan differences

Look for plan differences, including PPO network size and administration of benefits, payment structure, claims processing, and customer service support.

1. Evaluate the network organization and size. When reviewing the network included with the plan, consider the number of dentists available to employees. The network size should be large enough to meet the needs of employees and their families. It helps to have at least two dental offices in the network within five or 10 miles of the employer’s offices.

Note: Insurance carriers should revise network directories regularly. It’s frustrating for employees to contact dentists only to find they are no longer at that location or participating in a network. Ameritas regularly updates the provider online directory to ensure everyone gets the most up-to-date information.

2. Consider whether dentist credentials are verified regularly. The carrier should consistently check dentist and office credentials to ensure records are accurate, certificates are current, and there is regular participation in educational training programs.

For example, Ameritas network dentists are selected and credentialed based on established criteria reflecting professional education, training, and licensure standards. Credentials are verified upon initial application to the network and through re-credentialing. Dentists must have and maintain the appropriate dental license, malpractice coverage, DEA certificate (if required), and specialty license, diploma, certificate, or permit, as applicable.

3. Compare the fee structures for procedures. Most carriers can increase or decrease their contracted network fees by changing benefit levels, procedure placements, and reimbursement levels. Understanding how carriers structure fees is crucial since it can influence employees’ out-of-pocket costs. It pays to compare plans.

4. Check for rewards and incentives. Some dental plan designs include a rewards feature where members can increase their annual maximum benefit over time. For example, they could qualify to carry over up to $350 in unused benefits that can be applied to future dental claims. Without this feature, the plan’s annual maximum benefit resets yearly with no increase (rewards carryover).

5. Work with a knowledgeable insurance carrier. Before employers commit to a dental insurance plan, they should check the carrier’s reputation. Find out whether customers are satisfied with the coverage and how many stay with the carrier after the first year. Also, find out how long they’ve been in business and how fast they pay claims. Helpful information can be found on the insurance carrier’s website or social media platforms.

Plus, the insurance carrier sales representative should be an excellent resource for producers and employees, providing information on trends, plan features, and coverage levels, explaining industry issues, communicating the value of a dental plan, and making recommendations on changes that would improve the quality or cost efficiency of the plan. If a sales representative only shows up at renewal time, you may not be receiving the service you deserve.