What is a PPO?

March 29, 2024 |read icon 5 min read
Dentist giving child dental exam while he sits on his mother's lap.
Choosing the right dental insurance plan is essential when navigating options and understanding how to maximize benefits. The term PPO, which stands for Participating Provider Organization, often comes up. A PPO plan is not just a popular choice for many; it’s a gateway to a vast network of dental care professionals. But what else does it entail, and how does it stand out among other dental insurance plans? Let’s dive into the four core elements of a PPO to assist with making an informed plan decision.

1. Offers a large network of dental providers

A PPO is a group of dentists and specialists who have agreed to participate in the insurance company’s network and offer services at costs that are cheaper than their regular rates. Many people have a preferred dentist and don’t want to find a new one within the network to take advantage of the network savings. However, with a PPO plan, members can see any licensed dental, including those who don’t participate in the network; however, members receive the most cost savings if they see a network provider. Although there is a good chance the preferred provider is in the network, what if they’re not? Then, the patient can request that the insurance company invite the provider to join the network and see if the provider accepts. A PPO usually has an extensive network of dentists. Many participate in the plan to increase the number of patients they serve. When reviewing dental plans, members can see if their dentist is in-network by searching the insurance company’s provider online directory. Looking for a new dentist? Here are five tips for finding a dentist that fits individual needs.

2. Members spend less on dental care

Contracted dentists and specialists in a PPO network agree to provide services at discounted rates to members of the dental insurance plan. Plan members may pay a portion of the discounted price, with the plan covering the rest. It could be in the form of a deductible or the percentage of coverage, such as 100%, 80%, or 50% for different procedures. In addition, PPO providers may offer discounted rates on non-covered dental services as approved by state law. Again, while plan members can see any dentist, they’ll pay if the provider is not in the network. What’s important to remember is that network providers charge plan members reduced rates. No matter which dentist the member visits, the PPO plan will help cover costs. Dental plans prioritize preventive care to prevent tooth decay, including a dental exam, bitewing X-rays, and professional cleaning. The visit may also consist of space maintainers, fluoride, and sealants for children.

3. Helps manage dental claims

Dental plan members who visit a network dentist or specialist do not submit their claims. The network provider does that for them. Also, claims usually are filed electronically, so they are processed more quickly. Sometimes, out-of-network dentists will file member claims as a courtesy. What patients don’t like are unexpected expenses. Having claims paid as soon as possible prevents unexpected expenses.

4. Know dental costs in advance

Preventive (Type 1) dental checkups and professional cleanings are typically covered at 100% by dental plans, including PPO plans. Basic (Type 2) procedures may be covered at 80%, and major (Type 3) procedures at 50%. Before scheduling a dental procedure, ask the dentist what amount the plan covers. Dental providers also can submit a pre-treatment estimate to the insurance company to find out. Learn more by reading this blog on how to estimate dental costs. Learn more about standard dental terms, including PPO, here.

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