If you have Guardian Dental Insurance. Please answer my Question!?
Answers:
The difference between a PPO plan and an HMO-type plan is how your claims are paid. If you choose the PPO plan and see a dentist who is not on the preferred provider list, your insurance will still pay their percentage (usually 50%-80% for most procedures), but you will probably have a higher out-of-pocket expense. The insurance is paying their percentage of the fee that THEY allow for a procedure, but your dentist's fee may be higher. In this case, you are responsible for the entire difference, up to your dentist's fee.
If you see a dentist who is on the preferred provider list, you would be responsible for the 20% (or other amount) your insurance does not cover, but nothing extra, as the dentist has a contract with the insurance company that dictates what fees he/she can charge.
In an HMO-type plan, you must see a dentist on the insurance list in order to get any insurance benefit at all. If you see a dentist who is not on the insurance list, your insurance company will pay nothing.
This is a very general explanation. Every insurance policy is different, and financial policies will vary by dentist. Call your dentist and talk to the insurance coordinator for help with your exact situation.
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