How do I find a dentist?
- Simply click on Dental Insurance, Find a Dentist. You will need to look at your ID card to see which dental network you are enrolled in. Then type in either the City or Zip Code you are searching, select a mile radius, then click Search. The search results will display. Each search includes View Details, which offers additional information on the dental practice. Each search also includes a map for your convenience to see where the office is located.
My dentist does not participate, how do I request that he/she join the PPO network.
- You can download a Provider Recruitment Form from our website . The Provider Recruitment Form can be found under the Forms heading on the website. You can download the form in either Word or PDF format. Simply complete the form and return the completed form to us either by faxing it to 716-831-8080, or you can send it to us through our website. Simply click on Send a File, scan the completed Provider Recruitment Form and send it as an attachment to [email protected].
Do I have an assigned dentist?
- We do not assign dentists to subscribers. You have complete freedom of choice of dental providers. However, it is always in your best interest to have your dental services performed by a dentist who participates with us. Our participating dentists meet strict credentialing standards, and must abide by contract stipulations relating to standard of care. Also, you will pay less out-of-pocket by going to a participating dentist.
What is the difference between In and Out-of-Network benefits?
- In-Network benefits means you go to a participating PPO dentist. By going to a participating PPO dentist, you are receiving dental services from a dentist who has met strict credentialing standards. In addition, participating dentists will submit the claims on your behalf. A participating dentist has agreed to accept our schedule of allowances, therefore, may only charge you any applicable deductibles, co-insurance. They will not charge you over and above what the scheduled fee is. On the other hand, a dentist who is not participating does not agree to accept any fee schedule. He/she will charge you the difference between what the insurance company allows, and what their normal office fees are. It is the patient&rsquo;s responsibility to make sure the dentist is participating by asking the dentist&rsquo;s office prior to have any services performed.
How do I add a dependent?
- Generally, you may add a dependent to your plan at open enrollment, or if there is a qualifying event during the year. Please contact your Human Resource representative regarding how to add a dependent.
How do I change plans?
- Employer offers more than one plan, you can change plans only at open enrollment. Your Human Resource representative will explain to you when you are eligible for benefits, and when you can change plans.
Do you have Individual Dental or Vision?
- Yes, we do offer Individual Programs through Dental Pay Direct. Dental Pay Direct is a separate discount program for both dental and vision. The list of participating dentists is different from our fully-insured PPO plan, Dental Pay Plus. You can do a dentist search on our website for Dental Pay Direct. For a small annual fee, you will be able to go to a participating Dental Pay Direct dentist and receive discounted fees anywhere from 20-50% off of what the dentist normally charges. This is not insurance. This is a discount program that we have arranged with certain dentists. There are no claim forms, exclusions, limitations, deductibles, coinsurance, annual maximums or age limits. You do not have to be part of an employer group. Dental Pay Direct is available to any individual seeking to lower their dental and vision costs. For more information regarding Dental Pay Direct, please contact us 1-888-683-3682.
My Employer’s Dental Plan does not offer Orthodontia. How can I get coverage for Orthodontia?
- We offer a stand-alone discount Orthodontia Program through Dental Pay Direct. The program is called Ortho Direct. This is not insurance and is not affiliated with your dental insurance through Dental Pay Plus. Ortho Direct offers you a substantial discount off of Orthodontia treatment. You must have the Orthodontia work performed by an Orthodontist who participates with Dental Pay Direct. Orthodontists who participate with Dental Pay Plus may not participate with Dental Pay Direct. You would have to verify with the Orthodontist prior to receiving services if he/she participates in Dental Pay Direct. You can search on our website under Dental Pay Direct. Search by Orthodontist specialty. For more information on Ortho Direct, please contact us at 1-888-683-3682.