| Frequently Asked Question |
The Answer |
| How Do I Find
Participating Dentists? |
You can find a list of
these dentists on this website (click here).
Please remember to
confirm with the dental office when you make your
appointment AND before you receive services that
they still participate with your dental PPO
plan. |
| How do I obtain benefits
and eligibility information? |
All benefits and eligibility
information is obtained directly from the claims
administrator or insurance carrier listed on the
member’s benefits card. |
| What is a PPO Dental
Plan? |
PPO stands for Preferred
Provider Organization. In a PPO Dental Plan,
members enjoy the freedom to see any dentist from
the network of participating providers, including
specialists, without a referral. With a PPO
you will receive the highest level of benefits
when you seek care from a contracted network
dentist. Your out of pocket expense will be
significantly less if you access care from
"participating" providers. In addition, you
typically do not have to worry about any claim
forms or bills. |
| How Does a Dental PPO
Plan Work? |
With most PPO plans,
you may also choose to seek care outside the
network, without a referral. However, you should
know that care received from a non-network
dentist, facility or other health care
professional will usually mean higher out of
pocket costs to you. If you choose to seek
care outside the network, your insurance company
usually only pays a portion of those charges and
it is your responsibility to pay the remaining
amount. We recommend that you ask the non-network
dentist or health care professional about their
billed charge BEFORE you receive care.
|
| Will I Save Money if I
Visit a Participating Network Dentist?
|
Yes. Preferred Dental
Network PPO dentists have agreed to offer their
services to our members at a discount. This means
you will have lower out-of-pocket costs when you
visit dentists in the network.
If your dentist is
outside the network, you may be “balanced billed”
for charges in excess of the “Reasonable and
Customary” (R&C) limit. This means that
if your out-of-network dentist’s fees are higher
than the allowed R&C amount then YOU have to
pay for the excess.
See also:
Can I Find Out What My Dental Work Will Cost
Before I Have Iit
Done? |
| Can I Find Out What My
Dental Work Will Cost Before I Have It
Done? |
Yes. Just ask your
dentist to submit a "pre-determination of
benefits" to your dental plan – which tells you
in advance what is covered by your plan and
how much this will cost you. You can then
discuss your plans for treatment and payment as a
well-informed patient. If your dentist is not in
the network, this also tells you in advance if
your dentist is charging more than Reasonable and
Customary Fees. (see below)
A predetermination is
often required for treatment in excess of
$300. |
| What if a Dentist Calls
and My Insurance Company Tells Them I Am
“Not In the System” or That My “Coverage Has Been
Terminated”? |
This is usually just an
administrative issue and it can be corrected
relatively easy.
Simply check with your
Human Resource Department and verify you are
enrolled. They can assist you with
information about having claims reprocessed or
obtaining a new benefits ID
card.
|
| Do I File the Claim or
Does My Dentist? |
Participating dentists
will file claims for you. Non-Participating
dentists are not required to file on your behalf
but may be willing to do so.
If the
non-participating dentist will not file your
claim, simply have them complete a standard
American Dental Association (ADA) claim form and
you can submit the claim form to your dental
plan’s claims department.
|
| What Does “Reasonable and
Customary (R&C)” mean? |
Reasonable and Customary (R&C) means
charges that are typical for this dental procedure
in this geographical area. |
| What Does UCR
Mean? |
UCR (Usual, Customary & Reasonable)
means charges that are typical for this dental
procedure in this geographical area.
|
| What Does Balance Billing
Mean? |
Balance Billing is When a
dentist bills the patient for the difference
between what the plan will pay and the dentist’s
retail fees. |
| Do I Need to Select a
Primary Care Dentist? |
No – you do not have to select a
primary care dentist. There are no referrals, and
you can go to any dentist of your choice! Of
course when you stay in network, you'll get the
highest level of benefits for the lowest cost and
you'll avoid having to complete claim
forms. |
| My Dentist Does Not
Participate in the Network. How Can I Get
Him or Her to Join? |
If your dentist is not currently
participating in the Preferred Dental Network, but
would like to know more about the advantages of
participation, please ask him or her to call or
email us. You can also refer your dentist to us by
clicking on the Refer
a Dentist page within this website.
|
