Co-insurance payments: a typical breakdown for PPO plans.

  Insurance Patient
Preventive 100% 0%
Basic Service 75% 25%
Major Service 50% 50%

Co-insurance is applied differently to Preferred Provider Organization (PPO) and non-PPO claims.

Visiting a PPO dentist will typically result in lower out-of-pocket expenses because the dentist has agreed to lower negotiated fees.

In PPO plans, co-insurance refers to the percentage the insurance company and the patient are responsible for. It is the math behind how the insurance plan pays your benefits.

Co-insurance is generally applied after the deductible has been met and only applies to covered expenses.

Lump Sum Depletion

Example of how co-inurance works

  1. Dentist submits bill for a crown.
  2. Insurance estimates that covered charges equals $1450.
  3. Insurance plan notes that 50% is the plan responsibility and 50% is the patient responsibility (co-insurance).
  4. Insurance issues payment of $750 to dentist, patient issues payment of $750 to dentist.
  5. Dentist is paid in full for services rendered.