Denton Delta Dental

Dental PPO (Preferred Provider Organization) plans offer a network feature and usually offer a balance between lower costs and dentist choice. PPO dentists participate in the network thereby agreeing to accept contracted fees as payment in full rather than their usual fee for patients with the PPO. When you visit a PPO dentist, you typically pay a certain percentage of the reduced rate (called coinsurance) and the plan pays the rest. The percentage usually varies by the type of coverage such as diagnostic and preventive, major services, etc. For example, preventive services may be covered at 80% (you would pay 20%), while crowns and bridges may be covered at 50%. PPOs usually require you to meet a deductible and have an annual maximum amount of coverage (example: $1,000 per year).

While you typically have the lowest out-of-pocket costs if you visit a PPO dentist, the plan allows you to visit the dentist of your choice, even if she is not in the network.

We get asked this question everyday: “What’s the difference between seeing a dentist that’s in-network and one that is out-of-network?” The biggest difference is the amount of “out of pocket” expense that the patient pays. In other words, you will pay more seeing an out-of-network dentist. Fortunately for most families, Denton Smiles Dentistry is in-network with most insurance plans. Here’s some other reasons to stay in-network:

No Waiting for Reimbursement

When you are treated by a Delta Dental dentist, you don’t have to pay the entire bill and wait for reimbursement from Delta Dental. Instead, we pay your dentist directly, and send you a notice explaining your portion of the bill. You pay the dentist only that amount.  In some cases, if your insurance provider does not pay your portion then it is YOUR responsibility to pay the difference.

Less Paperwork

Delta Dental dentists handle all claim forms and other paperwork for you.

Delta Dental Dentists Agree to a Set Determination of Fees

For example, if you are responsible for a 20 percent co-insurance amount, you pay 20 percent of your dentist’s accepted or approved fee. We also make sure you are not charged extra for services that should be included in the cost of treatment. The only exception to this is if your insurance provider denies payment for your procedure.

This question is probably the most asked question behind the ever popular “will this hurt?” question. All dental insurance plans are different and the amount of coverage can vary between plans. It’s important to remember that your insurance plan was chosen either by yourself or by your employer. Denton Smiles Dentistry does not make the insurance rules—the insurance company does. As always, feel free to contact us and we’ll be happy to explain your insurance plan to you. For those who are more self-motivated, you can look up your specific plan details by visiting Delta Dental online.