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What is a Dental PPO?

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  • Written By: Malcolm Tatum
  • Edited By: Bronwyn Harris
  • Last Modified Date: 29 October 2016
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    Conjecture Corporation
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Adental PPO, or preferred provider organization, is a dental insurance plan that allows patients to obtain dental care at affordable prices. The structure of the dental PPO requires that individuals covered under the plan utilize the services of a dental professional that is part of the PPO’s network of providers in order to obtain the best pricing. Many plans of this type also include provisions for routine care such as an annual dental checkup.

A dental PPO is different from a dental HMO in several ways. One of the most important differences has to do with securing dental services. With the PPO, the patient is not necessarily limited to dental professionals who are in the network. Many plans offer reduced coverage if the patient wishes to see a dentist outside the network. However, it is very unusual for a dental HMO to cover any charges associated with services rendered by a dentist who does not have a contract with the health maintenance organization.

Another key difference has to do with referrals to dental specialists. With the dental PPO, the patient may or may not have to go through the primary care provider in order to see a specialist. In the case of a dental HMO, a referral must be obtained from the primary dental provider and the referral must be to a specialist within the network.

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There are a number of different dental PPO plans available today. Some of the plans offer basic services only, such as an annual checkup, fillings and teeth cleanings. Plans offering these types of services only tend to be relatively inexpensive. More comprehensive plans include forms of oral surgery that are usually not covered by health insurance as well as additional support services for general dental health. The plans may be offered as standalone medical coverage or be bundled in with a general health care policy.

One of the advantages of the dental PPO is the opportunity to take advantage of lower deductibles and higher coverage for different procedures if the patient chooses to use a dentist or dental professional that is part of the healthcare network associated with the plan. Dentists of this type are considered to be “in network” and have agreed to work with the provider in establishing payment limits and schedules for services rendered.

In addition to using an in-network provider, many dental PPO plans also offer some amount of compensation if the patient chooses to use a dentist that is not part of the network. Generally, there is a higher deductible that must be met, and the percentage of the total charges that the PPO will cover is usually reduced if the health care provider is not in the PPO’s network. However, there are exceptions with some plans, such as when the subscriber must seek dental care while visiting an area where the PPO does not have an established leg of the network.

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