We adhere to quality standards encompassing a broad range of care and service issues that are the cornerstone of our Quality Assurance Program (QAP). How is the quality of the network assured? There is no fee to join our PPO networks. Is there a fee to join your PPO networks? The credentialing process is based on standards developed by the National Committee for Quality Assurance (NCQA) and our provider network. All general dentists and specialists must be credentialed before being accepted as a participating provider. To receive information and forms to join our PPO networks, call Provider Relations at 80, email complete this online form. How will I know when a patient participates in one of your PPO networks?Īll eligible members will receive an identification card listing their PPO network. Our PPO networks include dentists contracted with Dental Health Alliance, L.L.C.® (DHA®) and dentists under access arrangements with other dental networks.
We offer the Sun Life Dental Network® and Sun Life Focus Network®. That way you can minimize unexpected expenses and avoid disappointment.What Preferred Provider Organization (PPO) Networks do you offer? It’s important to know how much is covered under your benefits plan (and how much you may be responsible for paying out-of-pocket). This means that after you submit your claim, you’ll receive 80% of the R&C amount, which would be $80 in this scenario. Your workplace plan also allows for 80% coverage of your massage therapy treatments. Let’s suppose you’re going for a massage that costs $130, but Sun Life’s R&C amount is $100. You can think of it as a ‘going rate’ in the market, because it reflects the average cost associated with a service or product in a particular region. What’s an R&C (reasonable and customary) limit?Ī reasonable and customary limit is the amount of money that Sun Life (or another insurance company) chooses as the normal range of payment for a specific health-related service or medical procedure. If any coverage limits apply to you, you’ll find them under the ‘Limits’ section of your coverage details. There may be some limits that apply to your coverage, such as a maximum limit to the number of visits you’re covered for any treatment or service.
How can I find out if there is a maximum number of covered visits, or any other limits, for my service? You’ll find your paramedical coverage information under ‘Paramedical Services’ list in the ‘Medical’ section of your coverage details. Examples of paramedical practitioners include acupuncturists, chiropractors, massage therapists, physiotherapists, podiatrists, Paramedical expenses are medical services or products received from a licensed medical professional who is not a medical doctor or a nurse. What are ‘paramedical’ expenses, and how are they different than ‘medical’ expenses?
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