Frequently Asked Questions PPO

FAQs

A participating dentist is a general dentist or specialist who has agreed to accept negotiated or lower fees as payment in full for treatments provided to those insured. Negotiated fees typically range from 15-45% below the average fees charged in a dentist’s community for the same or similar services.1

MetLife has thousands of general dentists and specialists participating in the network nationwide, so you will easily find one who meets your needs. You can see a list of participating dentists online at www.metlife.com/mybenefits or call 1-800-942-0854 to have a list faxed or mailed to you.

Each dental plan is unique. To understand what your own coverage levels are, you will need to look at your personal benefits plan. Go to ‘My Plan Coverage’ at www.metlife.com/mybenefits to learn more.

It’s possible that negotiated fees may extend to services not covered by your plan and services you received after your plan maximum was met. If permitted by law in your state, you may only be responsible for the negotiated fee.2

Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist your out-of-pocket costs may be higher. He or she hasn’t agreed to accept our reduced fees as payment in full. So you might have to pay the difference in cost between the dentist's fee and your plan's benefit payment.2

Yes. If you would like to encourage your non-participating dentist to apply, ask them to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.3

Your dentist will usually submit your claims for you which means you have little or no paperwork. But if they don’t, ask them to fill in the bottom portion of a claim form and mail it in yourself.

To learn more about how long it takes, click here.

You can track your claims online and receive an e-mail alert once a claim has been processed.

If you need a claim form, visit www.metlife.com/mybenefits or request one by calling 1-800-942-0854.

Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.

We recommend that you request a pretreatment estimate for services in excess of $300.

If you’re a participant in a dental plan from MetLife, you can access to the Dental Procedure Fee Tool on the www.metlife.com/mybenefits website. Use this tool to look up average in-network and out-of-network fees for dental services in your area. You'll find fees for different treatments and services such as exams, cleanings, fillings, crowns, and more.

Yes. Through international dental travel assistance services4 you can be referred to a local dentist for immediate care until you can see your own dentist.

Call +1-312-356-5970 (collect) when outside the U.S.

Benefits will be applied as out-of-network dental coverage.5

Please remember to save all receipts for submitting a dental claim after returning home.

The ‘coordination of benefits’ in dental benefits plans are a set of rules that are followed when someone is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits.

If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan.

If the MetLife dental benefit plan is secondary, most coordination of benefits rules require MetLife to determine the amount they will pay after the other company has paid first.

The amount of benefits paid by MetLife may be reduced due to the amount of benefits paid under the primary plan.

To determine which of your dental benefits plans is considered primary, refer to your dental plan summary.

1 Based on internal analysis by MetLife. Savings from enrolling in a dental benefits plan will depend on various factors, including how often members visit participating dentists and the cost for services rendered. Negotiated fees are subject to change. Negotiated fees for non-covered services may not apply in all states.
2 Negotiated fees are subject to change. Negotiated fees for non-covered services may not apply in all states.
3 Due to contractual requirements, MetLife is prevented from soliciting certain providers and not all dentists are eligible for participation.
4 International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife and any of its affiliates, and the services they provide are separate and apart from the benefits provided by MetLife.
5 Refer to your dental benefits plan summary for your out-of-network dental coverage or www.metlife.com/mybenefits and check My Plan Coverage section.