You may have read or been made aware of information being circulated on different web forums or social media postings claiming the majority of PPO plans to renew in 2018 will not include out-of-network benefits. We have investigated this claim and contacted a number of national companies and dental networks, including Aetna, Ameritas, Guardian, Careington, Cigna, Connection/GEHA, and Principal. We have concluded this generalized claim is untrue. All of the companies we contacted confirmed that the claim of a big change for PPOs to drop out-of-network benefits in 2018 has no merit.
However, EPO dental plan sales are on the rise. Insurance carriers (including Delta) sell cheaper plan options that require the insured patient to receive treatment from an in-network provider in order to utilize or receive any dental benefits. These are called Exclusive Provider Organizations. Patients who have an EPO plan have no out of network benefits (also referred to as a closed plan) and usually do not have to get referrals to see specialists. EPOs are not allowed (by law) in every state. Dentists who are preferred PPO Providers are not automatically in-network with their EPO plans.
Dental practices should continue to verify benefits as matter of course to ensure they can provide accurate benefit information to their patients. Keep in mind that in most cases, out-of-network benefits are determined by the patient’s plan, not the company, dental network, or TPA.
Please contact us should you receive any information directly from an insurance company regarding major changes to the plans they offer excluding out-of-network benefits.