Seeing a Dentist

Knowing the difference between network and non-network dentists can save you money

If you have one of our PPO dental plans, you can visit any licensed dentist and still have coverage. But, you usually will save money if you visit a network dentist.

Why do I save money if I visit a network dentist?

Because we’ve worked with our network dentists to negotiate discounted fees (or maximum allowable charges) for services. Our network dentists have agreed to accept these as payments in full for covered services.

That’s the big difference between network and non-network dentists. Network dentists can’t bill you for the difference between their standard charges and our negotiated fees, and non-network dentists can. Both will charge you for applicable deductibles and coinsurances, which vary based on your dental plan.

Delaware residents: please visit this page.

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What if I have a DHMO plan?

If you have a DHMO plan, you need to visit a Concordia Plus network dentist to receive any coverage under your dental plan. If you visit a non-network dentist, you will be responsible to pay the entire cost of that service out of your pocket.

Paying for a service from a non-network dentist

With a PPO, if you visit a non-network dentist, you may need to pay the dentist, submit a claim form and get reimbursed by your plan. Non-network services aren’t covered by a DHMO, so you would need to pay the entire cost of the service.

Do I need an ID card?

For PPO and DHMO plans, you don’t need to show an ID card to receive services—you can just tell your dentist you are a United Concordia member. But, presenting your ID card might be helpful to make sure your dentist has the correct information for your dental plan. In fact, if you have a unique member ID or client-assigned ID number (an ID that isn’t your Social Security number) we suggest that you present your ID card at the dentist.

Want to print an ID card?

You can print one anytime –just sign in to My Dental Benefits.

For the iDental discount plan, you will need to show your discount card to your dentist to receive a discount on services. This is sent to you in the mail after you sign up for your plan.

Do you have to file a claim for each dental visit?

It depends. Network dentists will file claims on your behalf. A non-network dentist may ask you to complete and submit your own claims.

Download claim forms here

Seeing a specialist

If you have a DHMO plan, you will need your general dentist to refer you to a specialist. But with a PPO plan, you don’t need a referral.

Need a referral form? Print one and bring it to your DHMO general dentist

Nominating a non-network dentist for participation in your network

If your dentist is not currently participating in the network, you can nominate your dentist by completing our online dentist nomination form. Your dentist may also contact us directly at 1-800-332-0366 from 8 a.m. to 8 p.m. ET.

Predetermination of benefits

If you expect your dental service to cost more than $500, it might be wise to ask your dentist to submit a predetermination of benefits to us to calculate how much of your dental services will be covered. This allows you to know up front what you can expect to pay out of pocket.

I want to see the details of my last dentist visit. Where can I go?

See your latest claims and read your EOBs online by signing in to My Dental Benefits. You can even read up on what’s covered and find a dentist in your network.