It’s important to understand that anytime you access the out-of-network benefit on the dental Point of Service (POS) plan, you will pay substantially more out-of-pocket. That is due to there not being any contractual agreement between the insurance carrier and the dental provider to offer services at a discounted rate.
When you seek services in-network, meaning, from dentists/providers listed in the EPO or PPO networks, you are paying less for services since these dentists/providers have agreed to provide services per the provider network discounts outlined in their contracts with the insurance carriers. When you pay 40% for major services in-network when seeking services from an EPO dentist, you are paying 40% of a contracted, discounted rate.
Below is an example of the difference between in-network and out-of-network services on the dental POS plan. Please keep in mind that this is just an example and does not reflect actual pricing of costs or services:
Principal Dental POS Example: You need a porcelain crown on a molar. We will assume the estimated charge considered to be usual, customary and reasonable is $800.
Applied Deductible: $0. No deductibles apply to any services accessed in the EPO network.
Your percentage of cost in the EPO network is 40%: You pay $320 or less. The EPO network discounts could be deeper, providing you with a lower out-of-pocket cost.
Total estimated cost in-network for the porcelain crown on a molar: $320
Out-of-Network: The out-of-network dentist decides to charge $1,000 for the porcelain crown on a molar. This dentist is not prohibited from charging what he/she feels can be charged for this service.
Applied deductible: $50
Your percentage of cost out-of-network is 40%, and usual, customary and reasonable is considered $800 for this service: You pay $320
AND, you owe the difference between the usual, customary and reasonable amount and what the out-of-network dentist decided to charge you ($1,000 - $800), which is an additional $200.
Total estimated cost out-of-network for the porcelain crown on a molar: $570
There is really no reason to seek services out-of-network unless you already have a relationship with a particular trusted dentist from whom you’ve received services in the past. Principal has a robust EPO and PPO network offering hundreds of dental choices in the greater Los Angeles area.
Garnett-Powers & Associates, Inc. is pleased to offer a University of Southern California PBP Customer Service Representative, dedicated to this program. Please address benefit and enrollment questions to:
Garnett-Powers & Associates, Inc.
23361 Madero, Suite 240
Mission Viejo, CA 92691
Or call us Monday - Friday, 8 am - 5 pm Pacific Time
Toll free at 1-800-319-9557
Contact USC-PBP Program Services
We thank you for the opportunity to be of service to you and your family.
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Program and benefit information contained on this site has been deemed reliable, but can change without notice.