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Financial Impact of Using PPO Dentists

Preferred Provider Organization (PPO) plans offer the following financial advantages:

- PPO dentists generally offer a 15% to 30% discount off their normal charges.

- PPO dentists generally agree not to balance bill their patients.

- PPO dentists have an acceptable billing practice.

- Plan incentives to promote use of PPO dentists include:
- waive or lower deductible for using a PPO provider.
- higher co-insurance paid by plan for using a PPO provider.
- higher maximum benefit for using a PPO provider.

The examples on this page are for education only. Please refer to your dental plan summary for specific information.

The following example incorporates many of the plan design incentives and an example of the potential claim savings generated by using a PPO dentist:

Type of Service PPONon-PPO
DeductibleNone $50 
Preventive services     100% 100%
Basic services90% 80%
Major services60% 50%


 PPO Dentistnon-PPO Dentist
Dentist charge for a crown$900$900
Less deductible- $0- $50
Dentist charge$900$850
Less PPO discount (20%)- $180NA
Covered charge$720$850
Patient co-insurancex 40%x 50%
Patient responsibility$288$425
Patient deductible+ $0+ $50
Total patient responsibility$288$475
Savings to Patient
$ 187
 





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