Cigna DPPO Network Provider

by Vu Le

05 27, 2016 | Posted in Blog, Dental News | 0 comments

Vu Le, DDS has been a proud Cigna in-network PPO provider since 2005.  If your employer offers the Cigna Dental Preferred Provider Organization coverage, you will have lower out of pocket costs by choosing a provider like us.  We encourage everyone we care about to choose a PPO plan over an HMO plan.  Not only will you have a wider choice of providers, but you will tend to experience a better level of care.

What is the Cigna DPPO?

PPO stands for Preferred Provider Organization.  Insurance companies like Cigna have to collect premiums from employers, then use that money to reimburse doctors for health care services. The remaining difference after administrative costs is their profit margin.  In order to offer lower premiums, insurers negotiate a reduced fee schedule with doctors.  Providers who accept these reduced fees get to join the PPO network.  In exchange for accepting the lower rates of payment, doctors get increased access to patients.

When a doctor performs a service on you, a claim is sent to Cigna.  The insurer reviews the claim, then pays an in-network doctor a reduced PPO contract fee.  The patient is responsible for the difference between the PPO contract fee and the amount paid by the insurance company.  Many offices, including our own, collect a deductible and/or an estimated co-payment on the date of service.   If the amount of insurance company payment is less than estimated, a supplemental bill is sent to the patient.  If the insurance company pays more than expected, a refund check is sent to the patient instead.

If an out-of-network dentist is chosen, then all of the same services can be performed, but there will be a higher out of pocket cost.  This is because the doctor charges their usual, non-discounted fee. On the positive side, you can select any dentist, not just those who are signed up with the carrier. Services still have to meet the same minimum requirements to get insurance company payment.  For example, you must have a significantly damaged tooth to have the insurance carrier pay for a crown.

The main benefit of a PPO is that it gives you, the patient, a balance of cost reduction and access to a wide selection of providers. A less visible, but more important advantage to most PPO’s is that it still leaves room for an honest dentist to make a living.

Cigna offers one variation on the PPO, the EPO. The Exclusive Provider Organization is basically a PPO plan, only without the option of paying more to see an out of network dentist.

Why not an HMO?

HMO stands for Health Maintenance Organization.  In the dental field, it barely fits the definition of insurance. The doctor is given $1-3 per month for every patient assigned to them by the insurance company. When the patient comes in for a service, the only other payment the doctor receives is a deeply discounted co-payment.  Checkups, x-rays and cleanings are routinely done without charge to the patient.  Unlike a PPO, the HMO provider receives no other money from the insurance company, outside of the trivial monthly capitation checks.  So for $12-36 per year, the doctor is supposed to provide two free cleanings and checkups.  With a hygienist costing $50 per hour, the dental office loses money on every routine visit.  The HMO dental office is effectively forced to find treatment in order to turn a profit, where a PPO office has a decent chance to break even. This is why corporately run HMO dental groups tend to have lower review scores than PPO providers. (read our reviews here) There are exceptions, but HMO patients have the odds inherently stacked against them.

Experience Quality

We’ve worked very hard to provide a high level of service with friendly staff and the latest technology.  Please contact us to schedule an appointment. If you are in open enrollment season, please contact your HR department to choose the PPO plan option.

 

 

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