PPO Plans
At Legacy Dental Group, we strive to offer all our patients the best dental care possible and never allow an insurance company to dictate patient care. Dental “insurance” is not really insurance at all, at least not in the same way as a medical plan. It is a defined, LIMITED dental benefit, ranging from $1,000-$2,500 (national average) in annual benefits that expires at the end of the current benefit year. These defined LIMITED dental benefit plans are not designed to cover all the cost of your dental care. In fact, they often contain waiting periods, pre-existing condition and missing tooth clauses, frequency limitations, deductibles, exclusions, etc. Nobody likes these kinds of surprises, but with these plans there are no guarantee of benefits and eligibility as each dental carrier will inform you and the dentist, “There is never a guarantee of benefits or eligibility. Any benefit or eligibility cannot be determined until a claim has been received and processed.” This often means that your dental care will be delayed or even never completed before the end of your benefit year or until your plan expires. The utilization of these plans are often minimal, which means you could be paying much more in premiums that you will ever realize in benefit. If this is your situation, ask us how you can avoid the pitfalls and confusion with these plans with our Legacy Dental Plan.
While most dental insurance used to be a noble institution and help for people, it seems like that is changing. Many dental practices are reducing the number of insurance companies they participate with or dropping them altogether. Many plans have slashed reimbursements or are not raising them in any appreciable way, even though every individual and every business has seen significant inflation and there is no end date we know where that trend slows. Wait times to speak with company representatives to obtain accurate benefits and eligibility information or to discuss claims issues or treatment have become frequently inexcusably long and when a representative is finally reached, they are difficult to understand because the call center being used is outside of the U.S. and often cannot resolve any issue. At the same time, while patient premiums may be going up, benefits usually don’t change much or at all. We are happy to research your dental benefits for you. Just provide us with the name of your employer and group number when you call. If you do not see your plan listed, please verify participation with your dental plan administrator or contact our office for assistance. We currently do not participate with AHCCCS or dental HMO/DMO plans.
During your company’s open enrollment, ask us which plan offering will work best in our office and to take the guesswork out of understanding your dental benefits.
We encourage everyone with a dental benefit plan to perform their own analysis with respect to the costs of the premium they are paying and the benefit they are actually receiving from their plan. If there is not enough realized value, then we encourage you to consider our membership plan. The Legacy Dental Plan is a simple and straightforward answer to the complexity of the claims administration nightmare. It’s simple to understand, simple to use and most of all, its AFFORDABLE.
We are in-network for many indemnity and PPO networks and dental benefit plans including but not limited to:
Aetna PPO
Ameritas PPO through leased networks
Careington PPO network*
Cigna PPO through leased networks
Connection Dental
Dental Benefit Providers PPO
Dental Health Alliance PPO
GEHA PPO
Guardian PPO through leased networks
Humana PPO
Metlife PPO through leased networks
Principal PPO through leased networks
United Healthcare Dental PPO*
Encore Dental Plans * these individual plans are administered through the United Healthcare Dental PPO network.
*DISCLOSURE NOTICE ON LEASED AND UMBRELLA PPO NETWORKS: Please be advised that while we make a good faith effort to verify any benefit levels and eligibility with any employer sponsored group plan or individual plan, due to any unforeseen internal changes to coverage and benefits those plans can implement without notice to the dental provider, we can make no guarantee of allowable fees or covered fees as they relate to any PPO or leased network participation. This means that while your benefit plan can tell us when verifying your plan benefits over the phone network “A” applies, once any claim is received any processed by them, the benefit plan reserves the right to change fee schedules for any PPO leased network to any claim. As many plans are not only complicated but utilize electronic and phone systems and call centers outside of the United States that have representatives with limited system capabilities that make it almost impossible for us to decipher what network your plan is in for our office, please verify which network your plan utilizes in our office with your carrier. Many employer group sponsored plans utilize “Leased Networks” and do not necessarily participate with the carrier indicated on your insurance or Dental Benefit Card. You will need to verify this information directly with your carrier, third party administrator (TPA), or the human resources and benefits department through your employer. For all Federal Employee Plans, any dental coverage you have elected as a standalone plan is considered as secondary coverage to your mandated medical plan that contains limited dental benefits and therefore, your medical plan must be billed as your primary dental coverage.
*Delta Dental of Arizona PPO and Premier: effective Feb. 1, 2022, Legacy Dental Group will no longer be an in-network provider. What does this mean for policy holders? In most cases, you can continue to have your dental care at our office and our office will bill your plan and receive the claim payment directly. Delta Dental has a nation-wide network from most states in the U.S. Each Delta has their own guidelines and policies regarding “Assignment of Benefits” to a dentist. Many depend on the arrangement an employer sponsored group plan has with an employer. Individual plans are generally not expected to allow payment directly to the dentist. As Delta Dental of Arizona does not permit policy holders and their dependents to assign any dental benefits to a non-contracted dentist, all dental services will be on a private pay basis starting February 1, 2022. *UPDATE: Arizona’s HB 2698 adds third party administrators to existing state law requiring insurers to allow patients to assign payment to their non-participating dentists. To date, Blue Cross Blue Shield of Arizona FEP and some Deltas, including some plans with Delta Dental of Arizona are not complying with this legislation. If this is affecting your coverage, contact your human resources or group administrator to voice your concern. Under Arizona State law, you have the right to assign your benefits to your provider.