Question: I have a dental PPO plan through work. I went to the dentist for a basic checkup and cleaning, and it was my first time going there. I do not have an issue with the dentist, but what I had done would be free minus my $25.00 deductible. However, I got a bill of $250.00 and was told I would need to submit the claim to the insurance company and get my money from them. They don’t do that as they want the payment when services are provided. I was surprised that I had to pay them in full, and luckily, I had the money to do so. Is this how the PPO dental insurance plan works? Am I always going to have to process my claims and wait for the money due back to me? If so, I am unsure how often I will want to use my dental insurance plan through work. I would prefer not to pay the part the insurance company owes. Are there any options for me not having to process dental claims like this?

Reply: It sounds like you’ve had a frustrating experience with your dental PPO plan. Understandably, you’re concerned about paying the full amount upfront and then waiting for reimbursement from the insurance company. Generally, with a PPO plan, you may have to pay for the services upfront and then submit a claim to your insurance company for reimbursement. However, contacting your insurance provider is worth confirming the process and seeing if alternative options are available. Some dental offices may be able to bill the insurance company directly, so it’s worth asking if this is an option. It’s important to fully understand your coverage and the claims process to avoid any surprises in the future. I will continue to break down additional options, and you can see which will work for you.

Understanding the Claims Process When Dealing With a Dental PPO Plan

When you have a PPO dental insurance plan, it’s crucial to grasp the claims process. Understanding how the dentist will file your claim before any services are provided is key to avoiding unexpected costs. Many dental offices that accept PPO dental insurance still require payment at the time services are rendered, leaving you to pay the full amount upfront and wait for reimbursement from the insurance company. This knowledge empowers you to manage your expenses effectively and avoid any financial surprises.

Some dental offices may provide an estimate of your costs based on your policy coverage and then charge or refund you the adjusted differences after the insurance company pays them. However, this typically occurs when you are an established patient. Therefore, it’s essential to inquire with the dental office staff about their claims processing procedures and what is expected from you regarding payment. Understanding these details will help you manage your expenses and avoid financial surprises.

Step-by-Step Guide – Submitting a Claim to Your Dental Insurance Company for Reimbursement Under a PPO Plan

When submitting a claim to your dental insurance company for reimbursement under a PPO plan, you should follow these specific steps:

1. Obtain a Claim Form: Contact your dental insurance company to request a claim form. This form will require you to provide details about the services you received, including the date of the visit, the procedures performed, and the charges incurred.

2. Complete the Claim Form: Please ensure that you fill out the claim form accurately and completely. Be sure to include all the necessary information, such as your personal details and the dentist’s information. Have the dental office fill out the dental services and coding for the services you received. Make sure to indicate on the claim form whether you or the dental office needs to receive payment.

3. Attach Supporting Documents: In addition to the completed claim form, you may need to attach supporting documents, such as the dentist’s itemized bill or receipt, and any other relevant documentation requested by your insurance company.

4. Submit the Claim: Once the claim form is filled out and all supporting documents are gathered, submit the claim to your dental insurance company. You can typically do this by mail or online, depending on the options offered by your insurer.

5. Follow Up: After submitting the claim, keep track of its status by monitoring any communications from your insurance company. This may involve checking for updates on your online account or contacting the insurance company directly if necessary.

By following these steps, you can ensure that your claim is properly submitted to your dental insurance company for reimbursement under your PPO plan.

A Dental Insurance Options Without the Hassle of Filing Claims.

With a dental HMO insurance plan, the need to file claims is eliminated because the insurance company has already pre-negotiated the cost for each dental service covered by the plan. This means that part of the policy packet includes a fee schedule for services, allowing you to know the upfront costs and pay the dentist only the pre-negotiated amount. Having an HMO makes it easier to budget for services, and there are generally no surprises afterward, as long as you review the services you will be receiving and ensure they match up with the fee schedule of the HMO plan. This straightforward process provides transparency and predictability, giving you peace of mind when managing dental expenses.

One potential downside to an HMO dental insurance plan is that it requires you to choose a plan provider and limits your treatment options to dentists within the plan’s network. This restriction means that your choices for dental care may be limited to the dentists who participate in the HMO network. It’s important to consider this when evaluating whether an HMO plan is the right fit for your needs, especially if you have a preferred dentist who may not be part of the HMO network.

In conclusion, navigating the claims process for a dental PPO plan can be challenging, especially when faced with unexpected costs and reimbursement delays. It’s essential to understand the specifics of your coverage and the claims submission process to effectively manage your expenses. Exploring alternative options such as a dental HMO plan, which eliminates the need to file claims, may be worth considering based on your preferences and financial situation. Ultimately, being proactive in understanding your dental insurance options and communicating with your provider can help you make informed decisions about your oral healthcare coverage.

Dental Insurance Plus

At DentalInsurancePlus.com, we offer a wide range of dental insurance plans tailored to meet your specific needs. Whether you’re considering switching from a PPO to an HMO plan or have any questions about dental insurance, our team is here to assist you every step of the way. We understand that navigating through dental insurance options can be overwhelming, and that’s why we’re dedicated to helping you find the right plan for you and your family.

Our comprehensive range of dental insurance plans includes HMO and PPO options, each designed to provide you with the coverage you need for a healthy smile. Whether you’re looking for a plan that eliminates the hassle of filing claims or prefer the flexibility of a PPO plan, we have you covered.

If you’re considering exploring your current dental plan options or have additional questions about dental insurance, we’re here to help. Please feel free to reach out to our office at 310-534-3444 during our office hours, Monday through Friday. Our friendly and knowledgeable staff will be more than happy to assist you and guide you through the process of finding the perfect dental insurance plan for you.

In California there are many good dental discount plans that are available. On our website we offer. Dental discount plans though Aetna, and New Dental Choice. Dental discount plans are a good low cost dental plan option. They do not have many of the limitations that dental insurance plans may come with.

Many of our dental discount plans start within the next business day of your on line enrollment. Which is very good for those people that are in dental pain since they can see a dentist right away. Dental discount plans are not for everyone. But they are a good way to reduce all your dental needs at a very affordable cost.

When deciding between dental discount plans carefully review their fee schedules. The fee schedules show the discount prices on what you pay for each dental service listed. You also want to make sure there is a dentist in the dental plan you want to go to. Since there is no outside network benefits. I suggest calling the dentist listed and confirming they are still accepting the plan as well as new members.

What is Discount Dental Plans?

A discount dental plan provides discounted dental prices through a network of dentists but is not a dental insurance company and in not an insurance dental plan and is not regulated by the department of insurance.

You can obtain quotes for more affordable dental insurance plans from companies online and through your local insurance agent or broker. Please keep in mind that there are many web sites who give the appearance of selling dental insurance but instead only offer a dental discount plan which is not insurance.

Your dentist may also have affordable dental plan options available to patients.  Ask the receptionist if they partner with a dental plan company and see if one might be right for you.

Question: I live in Virginia with my husband and three year old son.  My husband should see a dentist about a filling that came out four weeks ago.  He been putting it off since we do not currently have dental benefits and he thinks it will cost to much to fix.  I would like to find a low cost dental plan that will make my husbands dental cost lower.

Answer: I would suggest looking at one of our dental discount plans since your husband should see a dentist as soon as possible and you do not want to pick up dental insurance that would have waiting periods.  Our dental discount plans, will help to reduce the cost of him having a new filling put in and they are effective within the next business day with no waiting periods.

I am a working single mom.   I work part time so I can be at home when my child is off from school.  We do not have dental insurance and I am finding dental insurance to costly for me to get.  I been looking at some of the dental discount plans you have to offer but since I never bough a discount plan before can you tell me how they work?

Reply: With dental discount plans you are receiving reduce cost for your dental services at dental offices that are providers of the plan.  Most dental discount plans will provide a discounted fee schedule that shows your discounted cost for many dental services at a general/family dental provider office.  Normally for dental services not listed on this schedule you received 15-20 percent saving off the dentist normal charges for that service.   You will also received around 15-20 percent off any plan specialist cost if you choose to go to a specialist in the plan.  Note not all discount plans are the same so make sure you do read the plans terms and conditions to be sure of it’s benefits.

Reviewing your dental insurance plans I notice you also offer dental discount choices.  How would you advise someone who is thinking about getting a dental plan what to look for.  I can not afford the dental insurance choices I seen on line so it come down to getting a plan in order to save any money off my dental services.  I just not sure how to tell which plan would be better.

Reply: With dental discount plans here are a few things to check off to make sure you are getting the plan that right for your needs.

1) Compare cost of plans: Normally cost with dental discount do not very greatly but this still can be a factor for people.

2) Compare the plans discounted fee schedule for services that are listed. Most dental discount plans will provide a set discounted fee schedule that will show your discounted prices for different dental services provided by the plan general/family dental offices. Pick out a few dental services you feel you will be needing to compare cost with out having to compare each line item.

3) Compare the dental providers in each plan.  Choosing a dentist or making sure there are dental office in the plan you want to go to is important.  If you do not care for the dental providers that are in the plan the odds are you will not use it.  Make sure to call the dentist in the plan and confirm they are in fact still a provider and ask any other questions that may be important to you so that you feel convertible going to that provider under the plan

My son is currently in braces.  I have a dental discount plan that save me 20% and it has been working well for me.  However now my husband job is making us move.  My worry is that we will be changing states.  My son still has his braces and they will not be done in time for the move since he need them for another year.  Will I still be able to get my 20% discount under the plan with another plan dentist.

Reply: It can depend on the discount plan you have, such is the plan offer in the state that you are moving to? If so are their any providers in the area that you are moving to?  In general it should not be an issue since you had the dental discount plan when your son first started the orthodontic services. However, if you know the zip code of where you will be moving to, I suggest calling up your dental discount plan members service line and asking them these questions.

Well I come to a dission that I will be getting a dental discount plan.  My problem is I am not sure which one is the best.  Cost wise I see they are around the same give or take a few dollars.  How do I know for sure the one I get is the best plan.  Help in picking a plan is needed.