It’s essential to understand the features of your benefits plan – what procedures are covered, what the deductibles, coinsurances and annual/lifetime maximums are, and how much you and your employees will pay in premiums. While all those coverage points are important, the strength of the plan’s dental PPO network is equally so.

What is a dental PPO network?

A dental PPO network is made up of a group of dentists who have agreed to charge lower than their normal fees to employees who are covered by an insurance carrier’s PPO plan. Dental insurance carriers team up with a dental network to give their clients easy access to a wide range of dentists who accept their insurance at this discounted fee schedule. In turn, dentists in the network gain access to more potential patients. The insurance carrier negotiates set fees for each procedure with the network, so that both carrier and dentist know how much can charged. This amount is often less – sometimes significantly less – than what out-of-network dentists will charge.

What makes a dental network strong?

A dental network is strong when it consists of dentists who are credentialed according to the stringent guidelines of the National Committee for Quality Assurance (NCQA) and frequently re-credentialed to ensure ongoing adherence to those guidelines. These guidelines include measures to ensure that dentists are currently licensed to practice and carry malpractice insurance, among several other criteria. Dentists should meet these qualifications in order to be accepted. Once these credentialing guidelines are met, the next measure of a strong network is the discounted fees dentists accept that are passed on to patients. A strong dental network may provide savings of 50%-60% on preventive, basic and major procedures. 

How is a strong network beneficial for you and your employees?

• Lower costs. The cost for services from an in-network dentist is typically less than you would pay for the same service from an out-of-network dentist. That’s because when a dentist joins a network, they agree to accept the network’s fee schedule, with fees that are less than what they would charge as an out-of-network provider. The more employees use in-network providers, the greater the savings in claims cost – which can lead to potential premium savings upon renewal, and therefore further savings to both the employer and employee.
• Eliminates unknown expenses. Because in-network dentists agree to a certain reduced fee schedule, they can inform patients of costs for a procedure at the time of service. This means no surprise balance billing to the employee. 

To find an in-network provider, click here.