| Title | Description |
|---|
| 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. Preferred Dental Network does not have access to any benefits or claims information. |
| What is a PPO Dental Plan And How Does It Work? |
PPO stands for Preferred Provider Organization. In a PPO, 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.
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. |
| 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. |
| 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. This is further explained in the next question. | |
| 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 us to your dentist by clicking on the Refer a Dentist page on this website. |
| 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.
Although a pre-determination of benefits is typically not required, anytime you are going to spend over $300 in dental work – we suggest that you get educated up front. |
| What if a Dentist Calls and My Insurance Company Tells Them I Am “Not In the System” or That My “Coverage Has Been Terminated”? |
Remain calm – this is usually just an administrative error and it can be corrected within 1-2 business days.
Administrative errors happen in all businesses and it is easy to correct. A copy of your enrollment form, if available, should serve as temporary proof of coverage. Simply check with your Human Resource Department and verify you are enrolled correctly in the system. As soon as the administrative error is corrected, you can call the insurance company and have your claims reprocessed with no problem! |
| Do I File the Claim or Does My Dentist? |
Participating dentists will file claims for you. Non-Participating dentists do not have to file your claims for you. Some of them will and some of them will not – it really depends on the (out of network) dentist.
If the non-participating dentist will not file your claim, simply have them complete a standard American Dental Association (ADA) claim form or one of the Dental PPO claim forms on this website, and you can submit the claim form along with your itemized bill to your dental plan’s claims department. |
| “Reasonable and Customary (R&C)” and “Usual Customary and Reasonable (UCR) Charges” and “Balance Billing” – What Does This All Mean? |
These are all terms that apply specifically to out of network claims.
This NEVER applies if you are using in-network providers. They MUST accept the insurance company’s payment in full (less any deductible or coinsurance you may be responsible for). Out of network providers, however, can charge whatever they want. No rules apply to them!
If you go out of network, then the insurance company will only pay the "reasonable and customary" reimbursement rate for that service. If a member happens to be using a particularly expensive provider that is charging more than the "reasonable and customary" fees, then the member will be responsible for the deductible and coinsurance amount PLUS any charges in excess of R&C. Check with your plan to learn more about their specific R&C fee schedule. |
| How Do I Find Participating Dentists? |
Your Dental PPO is a plan with contracted participating dental providers. You can
find a list of these dentists on this website. You can also call the phone number on your Dental ID card and ask a member services representative to guide you to a dentist near you.
Always 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! PLEASE TAKE NOTE AND REMEMBER TO DO THIS!!! It is your responsibility to make sure you are using in-network dentists if you want to receive in-network benefits!!! |