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Q & A for United Concordia PPO Members
Are there any benefit maximums? Yes, there is a benefit maximum of $1,500 per member per contract year (July 1st - June 30th). There is a lifetime orthodontia maximum of $2,000 for dependent children. Orthodontia benefits cease at the end of the month in which the dependent child turns 25. Do I have to fill out claim forms after each routine visit? If you receive care from a United Concordia network dentist, you do not need to fill out claim forms—your dentist will take care of the paperwork. Under the PPO plan, you must submit claim forms if you are seeking reimbursement for services performed by an out-of-network provider.
If my dentist does not participate in United Concordia's Advantage Plus* network, can I still see him or her? Yes, you can receive care from any licensed dentist. If you choose to see a nonparticipating dentist, you will be responsible for the deductible and/or coinsurance amount, as well as any charges over and above United Concordia's reimbursement for covered services. Advantage Plus* network dentists accept United Concordia's reimbursement as payment-in-full for covered services, which means you are only responsible for the applicable deductible and/or coinsurance amount. Can I obtain the charge and coinsurance amount for specific services prior to receiving treatment? Yes, simply obtain the ADA procedure code and provider's charge from your provider's office. Contact United Concordia's Customer Service Department at 1-888-638-3384 with this information and they can provide you with your financial responsibility for the service, including any deductibles and coinsurance amounts.
How can I obtain a directory of participating providers? You may use the IVR system or speak with a Customer Service Representative to request a directory. Click here for current provider listings for general dentists and specialists participating in the PPO plan. To receive in-network benefits, members must receive services from dentists in United Concordia's Advantage Plus* network. You always have the option of receiving care from non-network providers under the PPO plan. Do I have to be referred to a specialist? No. Under the PPO plan, referrals are not required. To maximize your benefits, you may wish to utilize a participating provider. What about orthodontia for children? Orthodontic benefits are available for dependent children that are covered under the United Concordia PPO plan. Orthodontic benefits can be received from participating and nonparticipating providers. There is a lifetime orthodontic maximum of $2,000 per dependent child. There is no adult orthodontic coverage under the United Concordia PPO plan.
*Advantage Plus network available to Maryland and District of Columbia residents effective July 1, 2008.
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