Preferred Provider Organizations

Preferred Provider Organizations (PPOs) are an example of a managed care plan. In these plans, patients are required to select a dentist from a list who have contracted with the plan. The participating dentist agrees to charge a reduced fee (discounted fee) in return for an anticipated increase in the number of patients who select the office. If the patient’s dentist of choice does not participate in the plan, the patient will have a reduction or complete loss of benefits.

PPOs use various control mechanisms to maintain their costs. These could affect the treatment decisions you and your dentist make. Sometimes the plan will deny coverage for a service if you or your dentist do not submit your treatment plan for prior authorization. This is a contractual matter between your employer and the insurance company and is contrary to the policy of the Massachusetts Dental Society (MDS).

MDS is opposed to any dental clause that would deny or reduce payment, solely on the basis or lack of preauthorization.