Frequently Asked Questions About MetLife’s PPO Dental Plan

FAQs
 
What or who is a participating dentist?

A participating dentist is a general dentist or specialist who has agreed to accept negotiated or lower fees as payment in full for treatments provided to those insured. Negotiated fees typically range from 15-45% below the average fees charged in a dentist’s community for the same or similar services.1

How do I find a participating dentist?

MetLife has thousands of general dentists and specialists participating in the network nationwide, so you will easily find one who meets your needs. You can see a list of participating dentists online at www.metlife.com/mybenefits or call 1-800-942-0854 to have a list faxed or mailed to you.

What treatments and services are covered by dental insurance plans?

Each dental plan is unique. To understand what your own coverage levels are, you will need to look at your personal benefits plan. Go to ‘My Plan Coverage’ at www.metlife.com/mybenefits to learn more.

Does the MetLife PPO dental plan offer any discounts on services that aren’t covered?

It’s possible that negotiated fees may extend to services not covered by your plan and services you received after your plan maximum was met. If permitted by law in your state, you may only be responsible for the negotiated fee.2

Can I choose a non-participating dentist to use my PPO dental benefits?

Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist your out-of-pocket costs may be higher. He or she hasn’t agreed to accept our reduced fees as payment in full. So you might have to pay the difference in cost between the dentist's fee and your plan's benefit payment.2

Can my dentist apply for participation in the network?

Yes. If you would like to encourage your non-participating dentist to apply, ask them to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.3

(Please note that this website and phone number is specifically for dentists)

How are my PPO claims processed?

Your dentist will usually submit your claims for you which means you have little or no paperwork. But if they don’t, ask them to fill in the bottom portion of a claim form and mail it in yourself.

To learn more about how long it takes, click here.

You can track your claims online and receive an e-mail alert once a claim has been processed.

If you need a claim form, visit www.metlife.com/mybenefits or request one by calling 1-800-942-0854.

Can I find out what my out-of-pocket expenses will be before receiving a service?

Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.

We recommend that you request a pretreatment estimate for services in excess of $300.

How can I learn about what dentists in my area charge?

If you’re a participant in a dental plan from MetLife, you can access to the Dental Procedure Fee Tool on the www.metlife.com/mybenefits website. Use this tool to look up average in-network and out-of-network fees for dental services in your area. You'll find fees for different treatments and services such as exams, cleanings, fillings, crowns, and more.

Can MetLife help me find a dentist outside of the U.S. if I am traveling?

Yes. Through international dental travel assistance services4 you can be referred to a local dentist for immediate care until you can see your own dentist.

Call +1-312-356-5970 (collect) when outside the U.S.

Benefits will be applied as out-of-network dental coverage.5

Please remember to save all receipts for submitting a dental claim after returning home.

What if I am covered under two dental insurance plans; how does MetLife coordinate benefits?

The ‘coordination of benefits’ in dental benefits plans are a set of rules that are followed when someone is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits.

If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan.

If the MetLife dental benefit plan is secondary, most coordination of benefits rules require MetLife to determine the amount they will pay after the other company has paid first.

The amount of benefits paid by MetLife may be reduced due to the amount of benefits paid under the primary plan.

To determine which of your dental benefits plans is considered primary, refer to your dental plan summary.

 

Test your dental plan knowledge with this quick-to-complete quiz.