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Impacto económico al visitar a dentistas de los planes PPO

Términos:
Organización de Proveedores Preferidos (Preferred Provider Organization, PPO)


Los planes PPO ofrecen las siguientes ventajas económicas:

- Por lo general, los dentistas PPO ofrecen de un 15% al 30% de descuento en sus tarifas regulares.

- Por lo general, los dentistas PPO no cobran el saldo pendiente a los pacientes.

- Los dentistas PPO utilizan un método de cobro aceptable.

- Entre los incentivos del plan para promover el uso de dentistas PPO se incluyen:

- Exención o reducción del deducible al visitar a un proveedor PPO.
- El plan paga un coseguro más elevado al visitar a un proveedor PPO.
- Beneficio máximo más elevado al visitar a un proveedor PPO.

Los ejemplos que aparecen en esta página son sólo para fines educativos. Si desea información específica, consulte el resumen de su plan dental.

El siguiente ejemplo incorpora muchos de los incentivos diseñados para el plan y un ejemplo de los posibles ahorros al tramitar el formulario de reclamación después de haber utilizado los servicios de un dentista PPO:

Tipo de servicio PPO No PPOs
DeducibleNone $50 
Servicios de prevención    100% 100%
Servicios básicos90% 80%
Servicios mayores60% 50%


 Dentista PPODentista no PPO
Tarifa del dentista por una corona$900$900
Menos el deducible- $0- $50
Tarifa del dentista$900$850
Menos el descuento PPO (20%)- $180NA
Tarifa con cobertura$720$850
Coseguro del pacientex 40%x 50%
Cantidad que debe pagar paciente$288$425
Deducible del paciente+ $0+ $50
Total a pagar por el paciente$288$475
El paciente ahorra+ $0+ $50






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