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Dean George is the Marketing Specialist and Content Creator for Dental Insurance
Store and its social media channels. He is a regular contributor to Agent Straight Talk, the
only consumer blog explaining the ins, outs and in-betweens of dental insurance and
discount dental plans. READ MORE

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PPOs Offer Freedom and Flexibility

May 13, 2014

By Dean George

How many of you have ever bought into the illusion of a one-size-fits-all purchase, only to learn later that the outfitted size is for someone taller/shorter, skinnier/heavier, narrower/wider, or younger/older than you?

News flash: people are unique. Not only do we come in different shapes and sizes, but we also have different wants, needs and expectations. In the world of insurance, a one-size-fits-all plan is akin to expecting a Sumo wrestler to fit into a one-size-fits all tutu, or Cinderella and Mrs. Big Foot to fit into the same glass slipper.

Preferred Provider Organization

The uncertainty of one-size-fits-all is precisely why Dental Insurance Store offers different types of dental plans – because one-size never fits all. Heck, at my house we don’t agree on pizza toppings or on who let the dogs out. Which is why restaurants don’t sell toppings-that-satisfy-all pizzas and the Westminster Dog Show doesn't award “The Best in Show” to every Lassie wannabe or Air Bud clone.

To successfully market dental plans you need to accommodate different oral health needs, budgets, circumstances and expectations.  That’s why the whole idea of Dental Insurance Store is to offer plans to meet a variety of needs.

Last week Tooth Talk chat host Noel McCavity explained the advantages of one type of network plan when he interviewed a HMO.  Unfortunately Noel couldn’t be here this week because he tripped on some dental floss and tore his meniscus bicuspid, so I’m filling in to explain how Preferred Provider Organization (PPO) plans work.

Like Health Maintenance Organizations (HMOs), PPOs also offer managed care and save money by utilizing networks, but with an important caveat: PPOs allow members the freedom to use dentists in-network, or to use licensed dentists outside the network.

Visiting dentists outside a PPO network usually cost a little more than using an in-network dentist, but the plan will still pay for your treatment, unlike a HMO. If you’ll remember, HMO plans won’t pay anything towards the cost of your treatment when an out-of-network dentist is used. That is how the HMO business model controls costs and manages expenses.

PPOs also have larger networks than most HMOs. At Dental Insurance Store we represent Delta Dental and Renaissance Dental, both of which have extensive provider networks accepted at more than 114,000 dental locations. Another advantage to choosing a Delta or Renaissance network dentist is that they will submit claims for you and accept payment directly from the plan. Some PPOs require you pay the entire fee at the time of a visit, file the claim with the insurance carrier and then wait for reimbursement.

Speaking of fees, PPOs pay different than either HMOs or discount dental plans. Both HMOs and discount dental plans contract with dentists to provide dental treatment for a fixed fee. PPO plans instead negotiate a fixed percentage, usually 50% on major procedures, 80% on basic procedures, or 100% for most diagnostic and preventive services – if you use a network dentist. Again, if you use an out-of-network dentist your cost will be slightly higher.

For example, let’s say you have a dental exam and cleaning. The bill for both is $125, and your plan pays 80%. 

Dental Bill = $125
PPO plan pays 80% of $125, or $100.
You pay the difference between the $100 the plan pays and the $125 bill, or $25.

It’s important to know when considering PPO plans there are other considerations to think about (other than the premium) to see if such a plan is best for you. We’ll cover those in next week’s installment, but here’s a hint on one important consideration: health care insurance plans have them and so do auto insurance plans, although they cost considerably less in dental PPO plans.

If you’re guessing it has something to do with a talking gecko or gratuitous mayhem, do not pass “Go” and you may require summer school. We hope you return next week and read our follow-up installment on PPOs because we're saving a cyber seat for you.

Thanks for reading Agent Straight-Talk, and don’t be the last one in your neighborhood to follow us on Facebook, Twitter, Pinterest, Google+, and LinkedIn!  

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Copyright 2014, Bloom Insurance Agency, LLC   

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