BEN COMPARES COSTS
BEFORE HAVING A
ROOT CANAL.
Ben needs a root canal, so his dentist refers him
to two endodontists – one is in the PPO network
and the other is in the Premier network. Ben also
knows an out-of-network (non-participating)
endodontist who was referred by a friend.
To help him choose which endodontist to visit, Ben
researches what his out-of-pocket costs will be for
each. He calls each endodontist and obtains the
following pricing.
Note that Ben is enrolled in the Core dental
plan option.
Delta Dental
PPOSM Dentist
Delta Dental
Premier® Dentist
Dentist charge for a basic procedure
$1,000
$1,000
$1,000
Delta Dental negotiated fee/ *reasonable and
customary rate
$700
$880
$880*
Coinsurance amount (basic service)
80%
60%
60%
Delta Dental payment
$560
$528
$528
Patient payment
$700 – $560 =
$140
$880 – $528 =
$352
Non-Participating
Dentist
$880 – $528 = $352
+ $120* = $472
* Patient is responsible for amounts above the reasonable and customary rate ($1,000 - $880 = $120)
WHICH OPTION WAS RIGHT FOR BEN?
Ben chooses the provider in the PPO network because his out-of-pocket cost is lowest.
See the Benefits Enrollment Guide on the Benefits Resource site for more details about the dental
plan options available to employees of The Hartford.
This example and the others in the 2017 Annual Enrollment communications are intended solely to demonstrate how
certain health plan options or insurance coverages operate in a particular situation. The medical costs described are for
illustrative purposes only and don’t represent the actual fees that may be charged by a health care provider.
16-0852 © September 2016 The Hartford. All rights reserved.