PPO Insurance Plans

There are lot of resources out there to help patients understand their dental insurance, but what about understanding insurance from a provider standpoint? As a dentist in private practice, you need to understand how dental insurance works, what it covers, and what advantages and disadvantages it offers.

At Everest Advocates, our mission is to help dentists across the country understand PPO reimbursement rates, PPO dental plan fees, and dental insurance in general so you can realize the highest profit from the services you provide.

Dental Insurance: The Basics

There are a wide variety of dental insurance plans offered.  Most plans fall into one of these categories:

1.  A Direct Reimbursement plan that pays patients a specific amount based on what their dental care costs. These types of plans generally do not involve the dental provider’s office (except to get the bill), and the plan provider coordinates directly with the patient. Table or Schedule Allowance have a set price that they will pay for specific services, and do not take into account what the dentist charges for the care. Insurance Companies pay dental reimbursement rates to the dentist’s office directly. If the cost of care exceeds the amount the insurance will pay, the remainder is billed to the patient.
2.  Managed care, or PPO (preferred provider organization) plans are the most common types of coverage. With these plans, dentists sign up to be part of the network and agree to accept set fees and prices for specific procedures based on a contract. Generally that means you must accept the contract as is, although there are options for you to negotiate dental insurance rates as a provider in the network.

Limits to Coverage

One of the biggest obstacles for patients are the limits to the amount of coverage many dental plans provide. Insurance plans looking to control costs may have an annual limit on the procedures or dollar amount they will cover. When it comes to getting insurance reimbursement, it’s important that you know what the PPO reimbursement rates are, and how to negotiate PPO dental insurance fees.

Least Expensive Option Requirements

Another way that dental insurance companies control costs is by creating a requirement that dentists must follow the “least expensive alternative treatment approach” to care. It is important to know whether that is part of your contract so you get the proper reimbursement for the procedures you perform. If you are unsure about what the plan covers, seek clarification before you proceed with treatment.

At Everest Advocates, we are here to help dentists understand insurance contracts, learn how to develop good relationships and contracts with insurance companies.  Dental practices have to be profitable to provide the highest standard of care.

Contact our office today at 844.GO.4.APPS (844.464.2777), or through our easy-to-use web form to find out how we can help you make the most of your private dental practice.