Dental Plans Where I Can Use Any Dentist
When a dentist accepts insurance as a network provider, they have agreed to use the network's discounted rate fee schedule. They cannot charge
higher fees for any listed procedure. In simple terms, they have agreed to give you a substantial discount.
In almost all instances, if you use a network dentist, you will save money.
This sounds good in theory, but many of you do not want to change dentists. You don't care what they charge, you are not going anywhere.
You don't have to change dentists. We can provide dental insurance that will permit you to use at any dentist.
How These Plans Work
There are two types of plans that will give you the freedom to use any dentist; PPO and Indemnity.
Using a PPO Plan with Out of Network Dentists
Even though your dentist is not contracted with an insurance carrier and does not have to accept a plan's network rates, they can still submit a claim for you. But what does this mean?
When a dentist submits a claim to the insurance carrier, they list the codes used for your treatment. Every procedure performed has a special American Dental Association (ADA) code. The insurance company looks up what a contracted dentist would have charged and pays you based on that rate. They do not pay based on what the dentist charged you, unless it was the same as the contracted rate.
That is why dentists tell you to get a PPO plan. They know they can just submit the claim and not be held to the discounted rates. They can still charge you whatever they like.
I just wanted you to understand how this works. It is not uncommon for us to get a call that goes something like this "I have your PPO plan and you said it will cover major work at 50%. My wife had $1,400 root canal and I got a check for $275."
Here is what happened. The dentist submitted the claim to the insurance company. The PPO negotiated rate for a network dentist was $550. The insurance company paid 50% or $275. Now that you understand this, let's look at another alternative that might offer fewer surprises.
Using an Indemnity Plans with Out of Network Dentists
An indemnity plan is a dental plan that pays you or the dentist specific amounts based on the procedure codes your dentist submits in the claim. With the PPO you were shown how much you would pay the dentist.
With an indemnity plan has a chart of all the different procedures the dentist might perform, which is very similar to a PPO. However, in this case, instead of telling you how much the dentist can charge, the chart tells you how much the insurance company will pay you or the dentist.
A fast example will make this all clear.
Your dentist needs to do a filling and tells you that it will be $150. You pay the dentist the $150 and give him your insurance card to file the claim.
1. You have a PPO - the plan sees that the discounted or reasonable and customary rate for dentists in your area for the filling is $100. They are paying 50% with this particular plan and you get a check for $50 or half of what you would have paid a network dentist. You are out of pocket the difference of $100 (or $50 if the dentist was in the network).
2. You have an Indemnity plan - looking on the chart with all of the covered procedure codes we see that this plan will pay out $80 for this type of filling. You get a check for $80. They don't care what was charged, only that the work was performed.
If you are going to go to a dentist that does not take your insurance, we find that you are usually better off with an indemnity plan.
This plan is available in most states and we find it to be the most cost effective dental insurance plan we sell.