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Frequently Asked Question
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The Answer
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How Do I Find Participating Dentists?
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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.
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How do I obtain benefits and eligibility information?
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All benefits and eligibility information is obtained directly from the claims administrator or insurance carrier listed on the member’s benefits card.
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What is a PPO Dental Plan?
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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.
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How Does a Dental PPO Plan Work?
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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.
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Will I Save Money if I Visit a Participating Network Dentist?
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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?
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Can I Find Out What My Dental Work Will Cost Before I Have It Done?
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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.
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What if a Dentist Calls and My Insurance Company Tells Them I Am “Not In the System” or That My “Coverage Has Been Terminated”?
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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.
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Do I File the Claim or Does My Dentist?
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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.
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What Does “Reasonable and Customary (R&C)” mean?
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Reasonable and Customary (R&C) means charges that are typical for this dental procedure in this geographical area.
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What Does UCR Mean?
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UCR (Usual, Customary & Reasonable) means charges that are typical for this dental procedure in this geographical area.
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What Does Balance Billing Mean?
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Balance Billing is When a dentist bills the patient for the difference between what the plan will pay and the dentist’s retail fees.
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Do I Need to Select a Primary Care Dentist?
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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.
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My Dentist Does Not Participate in the Network. How Can I Get Him or Her to Join?
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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.
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