PPO
A PPO, or preferred provider organization, is a type of dental plan in which a practice that has signed a contract with the payer agrees to the plan's contracted fee schedule. Visits to practices outside the contract are paid under the patient's out-of-network benefit instead.
Why it matters to the front desk
In network, the allowed amount comes from the payer's contracted fee schedule rather than from the practice's own full fee. The difference between the two is the contractual adjustment the practice cannot collect from the patient, which is why the same procedure can cost a patient different amounts at different practices. Fee schedules also differ from one carrier to the next.
Practices set up each PPO plan in their management system with the carrier's contracted fee schedule, and the plan type and fee schedule affect how balances and adjustments appear on the patient's account. That is why a front desk confirms the plan type, the network status and the benefit details at verification, not only whether the coverage is active.
Related terms
Insurance Verification
Checks a patient's dental insurance with the payer, for one patient or the whole day's schedule, and returns coverage and benefits in a summary you can download.
See how Insurance Verification works