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Frequently Asked Questions

Dental PPO

Here you’ll find answers to the most common questions about Dental Choice. If you do not find the answer you're looking for, please contact us for assistance.

How many dentists are in the Dental Choice network?

Dental Choice has more than 212,000 participating dentists nationwide, including more than 54,000 specialists. You should have no problem finding a participating dentist in your area, while you are traveling, if you need emergency care, or for your eligible dependents who are away at college.

All participating dentists meet strict credentialing standards. They have also agreed to accept negotiated discounts as payment in full. This means you will have no balance billing for any covered services you receive.

How do I locate in-network dentists?

To search for a network dentist click here. Or you may call Customer Care at 1-866-498-7912.

I already have a personal dentist. Can I keep seeing him or her?

Yes. You may see any dentist you choose. However, you’ll receive the highest level of benefits by choosing a participating provider. When you visit a participating dentist, you pay your share of negotiated fees. This means lower out-of-pocket costs for you.

The dentist I want to use does not participate in the PPO network. Is there anything I can do to encourage him or her to participate?

Yes. The PPO network may add the dentist if he or she meets the credentialing standards. Either you or the dentist can fill out a request to add a provider to the network. Go to the customer service page. Be sure to include the provider's name and note that this is a request to have a provider added to the network. Please keep in mind that some dentists may choose not to participate in the network. Or the dentist's application may not be accepted.

Can my dependents visit a different dentist than I see?

Yes. You and your dependents each have the freedom to choose any dentist.

Can I switch dentists?

Yes. You can switch dentists as many times as you like. However, we encourage you to find a personal dentist you feel comfortable with and stay with that dentist. He or she will become familiar with your dental history and needs.

How and when do I file a claim?

Participating providers have agreed to file claims for you. If your dentist does not participate in our network, you may need to file a claim yourself. To get the claim form, visit the submit a claim page. When you visit a non-participating dentist, remember to take a claim form with you. Your dentist can help you fill it out.

How and when can I view a claim?

Employers, PPO members and providers can view a claim at any time by logging in to a secure Web site. Claim questions can also be answered by contacting customer care. Visit the submit / view a claim page for more information.

Where do I get a new ID card?

Employers, PPO members and providers can get help with an ID card by logging in to a secure Web site or contacting customer care.

How do I get reimbursed if I visit a non-participating dentist?

If you see a non-participating dentist, you may need to pay the entire bill at your visit. The charges could be higher than what you would pay for the same service from a participating provider. You or your dentist must submit a claim form to Dental Choice. We will send you an explanation of your benefits and reimbursement, according to your plan. If you have questions about claims or benefits, please call Customer Care at 1-866-498-7912.

What is a negotiated network fee?

A negotiated network fee is a discounted fee that participating providers agree to accept as payment in full for services they provide. Depending on the service, your plan may cover all or part of the discounted fee.

Do you require prior authorization for any services?

Dental Choice requires your dentist to submit a request for a prior authorization for any service that will cost more than $300. This typically applies to major services such as crowns, bridges, dentures, periodontal services, and oral surgery. Please consult your Evidence of Coverage, which explains your plan, for the most current information about prior authorization details.

For periodontal scaling and root planning, please ask your dentist to send the treatment plan and necessary X-rays or periodontal charting to Denex Dental. The mailing address is Group Dental Service, PO Box 4360, Rockville, MD, 20849. An agent will review the procedure(s) and send a response to you and your dentist within two business days.

Can I find out in advance how much a service will cost me out of pocket and get an estimate of what will be covered?

Yes, you or your provider may request a pre-treatment estimate to find out what your benefits for certain procedures will be. We’ll send both of you an estimate that show what services will be covered and at what level.

You can also use a new dental cost lookup tool on the Fair Health website to see cost estimates by U.S. geographic area.

What happens after I fill out my enrollment form? How will I know when I can start using my coverage?

You will be eligible for coverage starting on your group’s effective date. Check with your group’s benefits administrator to find out the date. We will send you a welcome packet with information on how to use your coverage. It will also include ID cards for the enrolled members of your family. Your Dental Choice Evidence of Coverage, which explains your plan, will be mailed to you separately.

Do I need an ID card to receive services?

No. You do not need to show your ID card to receive services. Tell your dentist that you are enrolled in the Dental Choice plan. They can call 1-866-498-7912 for verification. However, we encourage you to carry your ID card for your and your provider’s convenience.

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