When you schedule an appointment with your dental provider, one of your first questions will probably be: “How much will it cost?” We get it, and we’re here to help you understand your dental benefits a little bit better.
Beam offers PPO plans. PPO stands for preferred provider organization, and it means that we have a network of providers available to offer you dental care. These providers offer lower, contracted rates to be a part of the dental network. Beam may also cover a higher percentage of the cost when you stay in-network, depending on your plan.
However, you aren’t required to go to them exclusively. We know you may have an existing relationship with a provider who is out-of-network (OON). You don’t have to stop visiting them, and we offer strong OON benefits to offset the expense! Just note that it may cost a little more.
The guide below breaks down how the process works when you visit a provider and the differences between staying in-network and going out-of-network.
1. You schedule an appointment.
First, double-check whether your dentist is in the Beam provider network, Dentemax. You can give their office a call or use our Find a Dentist tool to verify.
2. You undergo a procedure, and the dentist submits a claim.
After your appointment, you’ll pay a deductible if your plan requires it and you haven’t met it yet and the dentist will submit a claim to Beam.
3. Beam receives the claim and processes it.
Here’s where things start to differ based on whether you choose an INN or OON provider.
When you visit an in-network provider: Once we receive the claim and determine whether the provider is in-network, we’ll apply coinsurance based on the type of procedure you received and your dental plan. Coinsurance is the percentage of a covered service you’re responsible for paying. Here are a couple of examples* to illustrate how this works:
• If you receive a dental cleaning, you likely won’t owe anything — most Beam plans cover diagnostic and preventative services at 100% and waive the deductible for these procedures.
• If you get a filling that’s covered at 80% under your plan, you’ll owe the remaining 20% plus a deductible if it hasn’t been met yet.
When you visit an out-of-network provider: We’ll apply coinsurance based on whether you have a UCR (Usual, Customary, and Reasonable) or MAC (Maximum Allowable Cost) plan. You can see which one you have in your benefits summary, which you can access at app.beam.dental. We know UCR and MAC plans are a little confusing, so check out our comprehensive breakdown!
4. Beam provides an explanation of benefits and sends their payment to your provider.
You’ll receive an explanation of benefits from us in the mail or via email. This document outlines the cost of your procedure, what the dentist charged, what we paid on your behalf, and what you owe. Your dentist will receive the same document. Note that this is not a bill.
When you visit an in-network provider: The provider will reach out to you if any balance is owed. However, there’s a good chance you won’t owe anything when you stay in-network for diagnostic and preventative services (e.g., exams, cleanings, X-rays). Under some Beam plans, basic services such as root canals and fillings are covered at 100% as well, although you may still owe a deductible*.
When you visit an out-of-network provider: While we offer strong out-of-network coverage that can cover the full cost in some situations, that won't always be the case. The dental office will reach out to you for the remaining balance owed.
You likely won’t encounter significant out-of-pocket costs when you visit an out-of-network provider, but in some cases, staying in-network is the most cost-effective option. If you have any questions about your dental benefits, give us a call at (800) 648-1179 or email firstname.lastname@example.org.