Tips to Maximize Your Dental Plan

If you are covered under a dental PPO (Preferred Provider Organization), you may have had questions on the benefits the plan provides. Sometimes it can be difficult to predict how much your out-of-pocket costs will be for a particular service so it is important to make sure you understand how your plan works.

Here are three things to look for when reviewing your dental plan:

1. Annual Maximum – An annual maximum is the maximum amount that the insurance company will pay out in claims for you for the year. If your dental plan has an annual maximum that applies, you should check to see when the annual maximum resets. If the annual maximum runs on a calendar year, that means that the full annual maximum resets every January 1^st, even if your open enrollment renewal date is July 1^st. For example, your plan could have a $1,500 annual maximum. You may join a dental plan for the first time and be effective July 1^st, 2018 and the plan year runs from July 1 – June 30^th. However, if the $1,500 annual maximum runs on a calendar year, you would receive a fresh $1,500 annual maximum to use as of January 1^st. This is especially important to consider if you have some upcoming dental work to schedule.
2. In-Network Vs. Out-of-Network: One of the most popular things about a dental PPO plan is that you are usually able to seek care from a dentist even if they are not in-network with your dental plan. However, it is important to remember that if you use an out-of-network provider, you can be balance billed for the difference between the dentist’s total charges and the amount that your insurance company will pay. If you can find an in-network dentist, you cannot be balance billed so seeking care from an in-network dentist is a more cost effective way to use your benefits.
3. Pre-Treatment Review/Predetermination: Because most dental services under a PPO plan are covered at a percentage, it can be difficult to determine how much you will be responsible for and how much the insurance company will pay. The best recommendation for this is to ask your dentist to submit a predetermination or a pre-treatment review for you. Your dentist will submit all of the procedure codes to your insurance company and then you will be able to see how much the insurance company would pay out for that service and how much you would be responsible for before you receive any of the services. This is a great way to manage your dental costs so you are not caught off guard with a large dental bill in the mail!

These are just a few ways to maximize your benefits under a dental PPO plan. If you have any questions, please contact your benefits team at Exude!