MetLife Preferred Dentist Program (PDP) Overview and Frequently Asked Questions
- How does the MetLife PDP work?
- What is a participating PDP dentist?
- How do I find a Participating PDP dentist?
- What is a negotiated fee?
- Do I need an ID card?
- Do my dependents have to visit the same dentist that I select?
- My dentist does not participate in the PDP. Is there anything I can do to encourage my dentist to participate?
- Can I find out how much services will cost and obtain an estimate of what will be covered prior to treatment?
- How do I file a claim?
- How does the MetLife PDP work?
With a dental benefit plan featuring the MetLife PDP, you receive benefits whether or not you and/or each eligible dependent visit a participating PDP dentist. But, when you visit a participating PDP dentist, you have the opportunity to maximize your benefit plan with access to lower, out-of-pocket expenses. The MetLife PDP is a Preferred Provider Organization, wherein you choose a provider at the time of treatment. You do not have to pre-select a primary dentist nor do you need an ID card or referrals for specialty care.
- What is a participating PDP dentist?
Dentists who participate in the MetLife PDP meet MetLife’s strict credentialing standards and agree to accept negotiated fees as payment-in-full for services rendered. There are more than 67,000 participating PDP dentists nationwide, including over 14,000 specialists. So you should have no problem finding a participating PDP dentist near your home or workplace, while you’re away on vacation in the continental U.S., or while your covered dependents are away at college.
- How do I find a Participating PDP dentist?
You can call the PDP automated Computer Voice Response line to obtain an up-to-date directory of participating dentists in your area. The system prompts you to enter your Social Security Number and a home or work ZIP code. A list of up to 205 participating dentists in the requested ZIP code is then mailed to your home the next business day. To receive your personalized directory, call 1-800-474-PDP1 (7371) Mon.-Fri. 6 a.m. to 11 p.m. ET or Saturday 7 a.m. to 4 p.m. You can also conduct online provider searches (with direction and mapping capabilities) via MetLife’s Dental Internet site at www.metlife.com/dental.
Please Note: Be sure to verify provider participation when you make your appointment.
- What is a negotiated fee?
A negotiated fee refers to the PDP fee schedule which participating dentists agree to accept as payment in full. The fee is typically 10% to 30% below average fees of dentists in your area. Your plan may reimburse you for all or part of the PDP fee. When you use a participating PDP dentist, you are responsible only for the difference between MetLife’s benefit payment amount and the PDP fee.
- Do I need an ID card?
Scott & White Health Plan will include MetLife information on your ID card. However, you do not need to present an ID card to confirm that you’re eligible. You should notify your dentist that you participate in MetLife’s PDP. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.
- Do my dependents have to visit the same dentist that I select?
No, you and your dependents each have the freedom to choose any dentist.
- My dentist does not participate in the PDP. Is there anything I can do to encourage my dentist to participate?
The MetLife PDP Network is continually expanding, and new providers may be added if they meet MetLife’s credentialing standards. Just ask your dentist to complete a MetLife PDP nomination card or visit the dentist directory online at www.metlife.com/dental, and MetLife will send him or her information on how to apply for participation. The timing depends on how quickly MetLife receives the necessary information. Please note that there may be instances where a dentist chooses not to participate and others where MetLife does not accept the application under their stringent credentialing requirements.
- Can I find out how much services will cost and obtain an estimate of what will be covered prior to treatment?
Yes, MetLife recommends that you have your dentist submit a request for a pre-treatment estimate for services in excess of $200.00. This often applies to services such as: crowns, bridges, inlays, and periodontics. When your dentist suggests treatment, have him or her send an undated claim form, along with the proposed treatment plan, to MetLife. A pre-treatment estimate will be sent to you and the dentist detailing an estimate of what services MetLife will cover and at what payment level.
- How do I file a claim?
Claim forms may be available from your human resources department or can be downloaded and printed out from MetLife’s dental website at www.metlife.com/dental. Remember to bring one with you to your appointment. Complete the employee portion, and your dentist will assist you with the rest. You can use the same claim form whether or not your dentist is a participating dentist. If you have a claim inquiry or benefit questions, please call MetLife’s Dental Customer Service Department at 1-800- ASK - 4MET (1-800-275-4638) after your plan’s effective date.
Like most dental insurance policies, MetLife group dental insurance policies contain certain exceptions, waiting periods, reductions, limitations and terms for keeping them in force. For costs and complete details of coverage, call or write MetLife.
Metropolitan Life Insurance Company, New York, NY 10010 L04057WQY(exp0505)MLIC-LD
Bookmark this Page
Print this Page
Resize Text
