Co-insurance payments: a typical breakdown for PPO plans.
| |
Insurance |
Patient |
| Preventive |
100% |
0% |
| Basic Service |
75% |
25% |
| Major Service |
50% |
50% |
Co-insurance is applied differently to Preferred Provider Organization (PPO) and non-PPO claims.
Visiting a PPO dentist will typically result in lower out-of-pocket expenses because the dentist has agreed to lower negotiated fees.
In PPO plans, co-insurance refers to the percentage the insurance company and the patient are responsible for. It is the math behind how the insurance plan pays your benefits.
Co-insurance is generally applied after the deductible has been met and only applies to covered expenses.
Example of how co-inurance works
- Dentist submits bill for a crown.
- Insurance estimates that covered charges equals $1450.
- Insurance plan notes that 50% is the plan responsibility and 50% is the patient responsibility (co-insurance).
- Insurance issues payment of $750 to dentist, patient issues payment of $750 to dentist.
- Dentist is paid in full for services rendered.