Many of our patients have asked this question: What is a PPO and do I have to go to their list of providers? In order to answer them I have put together the following to help explain. My answer is not all inclusive since insurances vary so much and I even have a tough time figuring them out. But anyway, here I go.
The latest statistics I have seen show that 78% of all dental insurances sold are dental preferred provider organizations (PPO's). What that means is that as a preferred provider dentist you agree to accept 15-25% less your normal fee for them to market and promote your practice to their list of patients. Most PPO's are in the 10-15% range, but many in some cases be up to and more than 30%, below usual and customary fees.
The good news is that unlike our medical partners whose PPO's have strict penalties (lack of coverage) for out of network providers, most dental plans do not. The reason for this is that dental insurers already restrict the annual amounts covered and pay limited amounts on major dental procedures (IE crowns, root canals, implants and even fillings). Most plans cover $1500-2000 annually which hasn't changed much in over 40 years since dental insurance reimbursement began.
The true impact of dental plans that require doctors to discount their fees is saving money for the insurance companies, not their patients, since an average comprehensive dental treatment plan is around $5000, most of which still needs to be paid out of pocket for the patient. The other impact is that doctors that participate must limit the amount of patients on these plans in order to continue to provide high quality of care and retain staff.
The best news is that most plans do allow you to see out of network dentists and they cover most maintenance fees and only limit coverage to some procedures by 10-15%. This 10-15% on major treatment is worth the cost since most of these offices are not high volume practices. These practices spend more doctor time with patients and provide high quality dental care. The other bonus is the doctor, unless he is an employee, works for the patient and not the insurance company and therefore has less conflict of interests. We all still work to help you maximize your insurance benefits.
Tell your friends and neighbors if they are on any of these plans they can still come to our office and that the out of pocket cost might be a lot less than they thought. We are welcoming new patients always and will work for you to maximize any insurance benefits you may be entitled to. Please feel free to call us if you have any questions. We always do a complimentary insurance evaluation and still file for all insurances. You don't always have to go to a list, at least in dentistry.