California PPO Benefits
How to get the Most out of Your Insurance Policy

1. PPO Networks and how to use them:

Although PPO policies state that you can go to any doctor, you get the best and lowest rates by utilizing the carriers within the network. This is called “In-Network Providers” as compared to “Out-of-Network” providers.

What to do: Go to the carrier’s website and search their on-line directory, call you carrier and ask them for a list of “in network providers,” or call your agent.

What not to do: Avoid making the biggest mistake people make of asking a doctor, “Do you take ‘XYZ’ Insurance?” The answer is always going to be Yes. However, the doctor may be in or out of the network and you could be exposed to a large out of pocket bill if they are out of the network.







2-Dental PPO:

All dental plans have a calendar year max allowance ranging from $500-$2500. If you have a large amount of dental work that you need to have done, start the dental work in November or December and finish it in January. For example, if you have a $1500 maximum benefit, you can have $3000 worth of work done within 60 days. Have your dentist max your $1500 in one calendar year and finish the work in the beginning of the next year. You will be happy and the dental carrier will be licking their “wounds” when having to pay these claims.

What to do: Talk to you dentist and identify how much your plan will pay and coordinate with him/her on how to coordinate your benefits.

What not to do: Not asking questions. Just don’t say yes to the dentist without asking your agent, the dentist office manager or your carrier how your plan pays or you could be on the hook for a large bill.





3-PPO Health:

All plans will have a deductible, even if it is zero. After your deductible is met you have further expenses called “co-insurance.” This is a percentage of the bill that you pay until you hit another threshold called “out of pocket maximum.” At that point you have 100% coverage for the rest of the calendar year.

What to do: Even though you don’t need approval to have procedures done, if you get prior approval you will know ahead of time what you’re our out of pocket expenses will be. Know your policy and have your doctor submit all procedures for pre-approval. This will speed the billing process up and not present any surprises to you.

What not to do: Don’t sign and agree to pay for any care without knowing your policy, and don’t just assume you have good insurance. You could be in for a big surprise when the bills start coming in.

Get your California Dental Insurance Plans quotes today.
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