Everything You Need to Know About Preferred Provider Organizations: PPO Insurance Plans

Like any form of insurance, dental insurance offers protection and coverage for financial losses; whether they be from the costs of dental care, cleaning, x-rays, root canals, or dentures. Dental insurance plans come in many forms, and different levels of coverage, prices for premiums, costs for deductibles, eligible providers, and so on. Deciding on the right plan for you and your family can be daunting at first.

What is a PPO Plan?

Most health and dental insurance fall under the broad category of “managed care” plans, providing particular rules about coverage in order to offer lower costs. The insurer has a network of providers that they negotiate with for discounts, though the plan generally only covers healthcare that is medically necessary or acts as preventative care.

PPO (or “preferred provider organization”) plans are one kind of managed care, defined by the degree of restriction imposed. Here, the insured party is encouraged to seek care from the insurance company’s network, but not required to. The incentive behind PPO plans is that in-network care has lower copay costs compared to that of out-of-network care.

How PPOs Work

Having a network of providers partnered with the insurance company is not unique to PPO insurance plans; however, these plans allow some flexibility for the insured party. While there is typically a small flat copay associated with in-network providers, out-of-network care entails a higher, percent-based copay―this contrasts with HMOs (health maintenance organizations) and EPOs (exclusive provider organizations) where no coverage is given outside of the network.

Preferred provider organizations (PPO) do not require a designated primary care physician (PCP) to give you referrals for specialists which allow for additional flexibility. This flexibility is, however, offset by higher monthly premiums relative to other managed care plans. PPOs may sometimes require prior authorization on services before they will provide coverage, and may need you to file a claim for reimbursement.

Is PPO Insurance For You?

PPO insurance plans are gaining popularity because―despite there being plans with lower premiums―the offered flexibility surpasses any of the alternatives. If you are deciding whether to sign up for a PPO plan, consider some of the primary benefits:

  • Do you already have a physician or medical team that you prefer to go to but don’t want to leave them because they’re out of your plan’s network? A PPO plan will let you continue to visit your existing physicians; patients with chronic conditions benefit from this because their doctors are already familiar with them.
  • Do you travel often or otherwise need to visit medical providers away from your usual go-to? With PPO insurance, you can be sure that you’ll get coverage instead of having to work out in advance where you can go; costs may be higher, but the guarantee of coverage is often worth it.
  • Do you require or prefer quicker treatments for a particular health condition outside of general practices? PPOs don’t ask you to choose and visit a PCP to obtain a referral before visiting a specialist; this saves you at least one trip for dealing with complex issues.

Use Your PPO Coverage At Nevada Sun Dental

At Nevada Sun Dental, we are ready to help you with payment plans for your dental care as our practice accepts most PPO dental insurance plans. While our friendly staff gets your teeth the care they need, we can negotiate with your insurance company and walk you through what you need to know about payment. Contact us today to schedule an appointment and get started!

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