PPO stands for Preferred Provider Organization and it’s a dental insurance plan that lets you choose the dentist you want. However, your benefits may be different if you see an in-network vs. an out-of-network dentist. Typically, PPO plans provide more coverage toward in-network appointments than out-of-network ones. For example, the percentage of the appointment covered for an in-network dentist might be higher than the coverage provided for an out-of-network dentist, or your co-pay may be lower for in-network appointments. Many PPO plans have very comprehensive coverage for out-of-network providers though. At Mukilteo Smiles, we are an in-network provider for Delta Premier and PPO, Regence, United Concordia Tri-Care, and United Concordia Elite Plus.

Yes, you can. We are currently an in-network provider for Delta Premier and PPO, Regence, and United Concordia Tri-Care and Elite Plus, but we can provide care to patients with other dental insurance plans. Your coverage and/or the reimbursements with your out-of-network plan may vary greatly. We can contact your insurance company for you to get information to help you understand your patient responsibility for the costs for different treatment options. However, it’s important that you contact your insurance provider before your appointment, so you understand an overview of your coverage before coming in.

We base our treatment recommendations on comprehensive exams and diagnosis as well as discussions with you about the best option(s) for your health, comfort, and personal situation. Insurance companies prefer to pay for the least expensive treatments without taking into account the complex and individualized needs of the patient. Our recommendation may not always align with what your insurance company approves. When this situation arises, we will work with you to give you the best possible outcome, taking into account all factors from your long-term prognosis to your financial considerations.

A pre-determination helps you get an estimate of your dental fees. It is a claim sent to your insurance company telling them what treatment needs to be done. Your insurance then sends back a list of what they would cover for those services. Keep in mind the pre-determination is a guideline tool from the insurance company and not a guarantee of payment.

Dual coverage is when you one insurance that functions as your primary insurance as well as a secondary insurance plan. If your secondary insurance has a standard clause, it means the secondary will pick up a percentage of the cost of whatever the primary doesn’t. That’s dual coverage. However, keep in mind that your secondary will not pick up anything left over from the primary insurance if it has a non-duplication clause.

DMO stands for Dental Maintenance Organization. It is a type of insurance plan that requires the subscriber to sign up for a specific dentist when they enroll, and the insurance company will only pay for that dentist. Mukilteo Smiles is not a DMO provider for any plans.