PPO vs Non-PPO Dentists

The most significant difference between a Preferred Provider Organization (PPO) dentist and a non-PPO dentist is the discount the PPO dentist gives to the patient. The discount lowers the patient's out-of-pocket costs. With a PPO plan, the patient has the option of selecting any dentist for their treatment.

In addition to the discount, PPO dentists agree to a background check of their license, previous patient complaints and malpractice history. If the PPO dentist is approved, they are accepted into the network. Non-PPO dentists do not discount their fees and do not agree to have someone review their practice information or credentials.

There are also differences between non-PPO dentists
The key differences between PPO and non-PPO dentists can be simplified to three elements. PPO dentist agree to discounted fees, and a review of their professional credentials and billing history. There are dentists who have good professional credentials and billing history, but who chose not to join to a PPO because they prefer not to discount their fees. The chart below highlights the key differences.

THE DIFFERENCES BETWEEN DENTISTS



Discount Fees:
- PPO dentists discount their fees, which can reduce your out-of-pocket expense. Non-PPO dentists do not discount their fees.

For more information see Financial Impact of Using PPO Dentists

Balance Billing:
PPO dentists contractually agree not to bill the patient for the difference between the dentist's actual charge and the amount reimbursed under the patient's dental benefits plan for covered procedures.

For more information see UCR Fees & Balance Billing

Non-PPO dentists can bill you for the difference between their actual charge and the amount reimbursed under your plan.

Approved Treatment Habits:
The dentist's treatment records are collected and reviewed to understand their treatment habits.

Approved Credentials:
The dentist's credentials are reviewed, verified and approved or not approved. Examples of credentials checked include malpractice history, license status, sanctions and proof of malpractice insurance coverage.