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Dental PPO Networks

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COVERAGE

• PESC Administrators manages dental PPO networks throughout California to provide employers with statewide access to discounted dental fees.
• Each of the dental PPO networks developed its own discounted regional PPO fee schedule and contracted with participating dentists who agreed to extend these discounts to patients.
• Fee schedules generally fall within the 50th percentile of the National Dental Advisory Fee survey and represent discounts of approximately 25%.
• PESC Administrators offers dental PPO networks with discounted fees for general dentists and specialists
• Few (if any) insurance companies or privately owned dental networks have as many participating PPO dentists and specialists in northern California from Santa Barbara and Bakersfield north to Redding.
• Dental PPO networks managed by PESC Administrators include:
  • Central Valley Dental Partners (San Joaquin Valley from Modesto to Bakersfield)
  • Central Coast Dental Associates (Salinas and Monterey to the Bay Area)
  • Dental Alliance Sacramento (greater Sacramento metropolitan area)
  • PESC Administrators (Southern California)
  • Mid Coast Dental Alliance (Ventura, Santa Barbara, and San Luis Obispo Counties)
  • Dental Alliance Nevada (State of Nevada)
• PESC Administrators is affiliated with dental PPO networks in other parts of the country to provide national coverage including:
  • Dentists, Inc. (Texas)
  • Adenta (Ohio, Illinois, and Kentucky)
  • MDNY (New York)
• Dental PPO networks provide new groups with complimentary toothbrushes, toothpaste, and floss cards along with flyers for employees explaining the value of using PPO dentists

CREDENTIALING

• Dentists are credentialed before they are allowed to join PPO networks and are re-credentialed annually to insure they meet high quality standards for participation
• Credentialing includes checks of licensure with the California Board of Dental Examiners, verification of current DEA and CPR certificates, and confirmation of adequate levels of professional liability insurance.

QUALITY ASSURANCE
PPO network dentists sign participating provider agreements obligating them to:

• treat patients covered by self-funded dental plans with a consistent high quality standard of care
• offer patients convenient appointment times
• insure all materials and techniques meet accepted professional standards for quality
• discount their fees to the applicable regional PPO fee schedule
• insure that patients are not "balance billed" for the difference between the dentists' usual and customary fees and discounted PPO fees
• abide by dental plan benefit provisions, limitations, and exclusions as defined by the employer sponsoring the plan
• be subject to all decisions of dental peer review committees

PEER REVIEW

Each dental PPO network maintains a Peer Review Committee which is available to resolve patients' concerns about quality of care, appropriateness of treatment, and billing. To access the peer review system, patients obtain a Peer Review Request form from the PESC Administrators office. The peer review process will be activated within 14 days of receipt of the completed form from the patient.

 

 

555 W. Shaw Ave., Suite C-1 Fresno, CA 93704

(866) 777-1320 (559) 256-1320 559.256.1321 fax