PPO Dental Insurance Plans

ppo dental insurance

If your dentist told you to get PPO dental insurance because that is all they will accept, you are in the right place.

Take a minute or two and read this page. I will explain in layman's terms how these plans work and what to watch out for. Of course you can always give us a call and we will be glad to guide you through all of this.

You went to the dentist and now need a few crowns, root canals, bridges, etc. The bill will cost more than you put down on your home. You asked about dental insurance in the dentist's office and they told you they only accept PPO dental plans. So begins your quest for the "holy grail" of dental insurance - the PPO dental plan.

“My dentist told me to find a PPO dental plan.”

You would think that all you need to do is find a PPO dental insurance and everything will be fine. The universe will be in perfect alignment.

Unfortunately, most people do not understand how these plans work and still end up with huge bills. When a dentist tells you that they will take any PPO plan, as opposed to a specific plan, what they really mean is:

"I am not a authorized network provider for every PPO dental plan. As a matter of fact, I might not take dental insurance at all. If I am not in the network or do not take insurance, I will charge you what I feel like for my work.

If I am in the plan's network, I will give you a discount on all services because they hold my feet to the fire as to what I can charge you. You will probably save a lot of money over my regular rates."

This is very important. The dental office that does not take insurance or is out of network is only going to submit the claim for you. Which means they will mail an insurance form to the insurance company. However, when the insurance company writes a check, they are basing it on their discount rates.

I know, that sounded a little confusing. A simple example will make this clearer.

Your dentist tells you that you need to have a root canal. They quote you $1,200. The dental office has told to get any PPO plan and that it does not matter which one. You have the work done, pay the dentist $1,200.

You are thinking that since your insurance plan covers 50% will send you a check for $600. But, that is not how it works.

When the check comes it is for $300. Why? Because if you had gone to a dentist in the PPO network, they would have charged you $600. That is the allowable rate. As a network provider they would not be allowed to charge more.

Remember, the insurance company pays out based on the network rate and not whatever the dentist feels like charging that day.

The lesson here is to try and find a provider that is in the plan's network. I realize that some of you would not change to another dentist under any circumstances. Just be aware that your loyalty comes with a price.

A 60 Second Explanation on How PPO Dental Insurance Works

This might be a better example.

A PPO consists of a network of dentists who have agreed upon a pre-negotiated, discounted price for their services. Depending upon what procedure is being performed (filling, cleaning, etc.), you will only have to pay based on this discounted rate.

The plan will pay for a percentage of this discounted rate and you will pay the rest. A typical plan might look something like this:

Service Plan Pays You Pay
Preventative Services (cleanings, x-rays, etc.) 100% 0%
Basic Services (fillings, minor extractions) 80% 20%
Major Services (crowns, root canals) 50% 50%

There is also a cap on the total amount the insurance company will pay per person per year. This varies from $750 to $2500 per annum, per person. Our small group plans can go up to $3,000 per person.

What happens if you need a lot of work and use up your annual allowance of coverage?

If you already got paid on the maximum amount of coverage for the year, the insurance company will not be writing any checks until the next plan year.

But remember, you were getting discounts on all of the work. If you can still get the discounts that will save you a lot of money.

Here is the problem. Some dentists will continue to extend the network's discount to you. That is the right thing to do. They do not have to offer this to you. It is their decision regardless of what they tell you. In our opinion any dentist that does not extend the PPO pricing is just plain greedy.

Indemnity Plans with PPO Network - Your Best Bet?

There is another type of plan that you can use with any dentist. It is called an indemnity plan. Often, these plans are a better alternative. Here is how it works.

The plan has a chart of all the different procedures the dentist might perform. This is essentially the same way a PPO works. 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.

The advantage to the indemnity plan is as follows:

  1. Your out of pocket expenses are often lower - especially with out of network dentists
  2. You can use any dentist you want
  3. The cap goes up to $2,500 instead of $1,000
  4. Some plans include vision coverage

Plus, the plans include a PPO network so you also get the discounted rate when you stay in network just like a traditional PPO. An indemnity plan has a lot of advantages and is worth considering.

Our PPO Dental Plans

Spirit PPO Dental Insurance

Spirit PPO plan has no waiting periods. Like some of our other plans, it covers everything in the first year and increases the amount of coverage in the second year.

What is very unique about this plan is that it can optionally cover up to $3,500 a year in expenses. None of the other plans will do this. You can also add vision coverage to it.

Unlike other plans, Spirit Dental PPO will cover 3 cleanings per year. Even though you hate to step foot in the dentist's office, having your teeth cleaned every 4 months instead of every 6 months will make a real difference. You will have fewer cavities, less gum problems and your cleanings will be a breeze.

I find the premiums for this plan, especially the $3,500 coverage, to be a real bargain and the network exceptionally large nationwide.

Use the Maximum Care Dental Network Lookup Link to check for your dentist or a dentist near you.

CompleteCare PPO with Careington PPO Network

This plan has no waiting periods for anything. But there is a catch. Preventative (like cleanings and x-rays), fillings and extractions are just a small copay if you stay in network. Everything else is covered on a reduced fee basis.

However, this plan uses the Careington PPO network which is different from their discount network. There are a lot of good dentists who will take this plan. Plus, there are no dollar limits to the coverage. It can still save you a bundle of money and allow you to keep your dentist. Worth checking out.

The next plan is an indemnity plan with PPO networks. Once again, you can use any dentist.

Core Dental with Ameritas PPO Network

Core Dental has a higher limits than any other plan and provides coverage of up to $2,500 per year. It will cover preventative, fillings, simple extractions and denture repair with no waiting period. Major procedures have a 6 month wait. If you can wait the six months, no plan offers a higher benefit.

This plan includes a great vision plan for no extra cost.

For Assistance in Selecting a PPO Plan - 800-272-0512

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