-PPO plans appear similar to indemnity plans but differ in that
PPOs contract with individual dentist who agree to offer discounted fees
in exchange for pools of patients.
-As a general rule, a contracted dentist must deliver treatment.
Iftreatment is done by a dentist outside of the PPO’s contracted dentists, treatment
is either not payable or payable at a reduced rate
Advantages
-PPO plans are less expensive
-PPO limit the co-payment that dentist are allowed to charge patients,
thus reducing out-of-pocket costs.
Disadvantages
-Patients have a limited choice of dentists and dental specialists to
receivefull benefits.
-The pool of dentists participating in a PPO may change from year to year.
-Benefits may be confusing to employees
-Promised benefits "by-report" are usually not payable.
Purchase considerations
-Determine the number of dentists participating in the area where
employeeslive and work.
-Select a PPO that allows the employees the option of going to a
non-participating (keeping in mind that benefits are reduced and co-pays are increased).
-Determine the access to dental specialists.
-Request a copy of the PPO’s contract it has with its providers. It
will better detail types of treatment employees are entitled to receive.
-Request a fee schedule from the PPO, and compare it to your current
dentist’s.
