In-Network vs. Out-of-Network Dental Insurance: What’s the Difference?
As if finding a dentist that’s right for you and your family wasn’t hard enough, taking the time to understand dental insurance in Plano can be even more difficult. For example, you’ve probably heard the terms “in-network” and “out-of-network” when reading about your options for insurance, but may not have known exactly what they mean or how this affects your costs. Keep reading to learn what you can expect when visiting a dentist that’s in-network vs. out-of-network.
What Does “In-Network” Mean?
Also known as participating providers, in-network dental offices agree to contracts with dental insurance companies. In these contracts, the dentist agrees to charge negotiated rates for specific services. If you choose a dentist that is in-network with your insurance provider, you’ll be more likely to spend less when the time comes to pay for these services.
Additionally, preventive services like cleanings, checkups, and X-rays often receive 100% coverage from your dental insurance plan when you choose an in-network dentist, but this is not always the case. Other times, it may be close to 100% coverage. Even so, your out-of-pocket costs will usually be quite low.
With that said, not all dentists are going to be in-network with your plan. That means your options are more limited. You’ll also still need to pay your deductible to access your benefits at all.
What Does “Out-of-Network” Mean?
It’s not uncommon for dentists to be out-of-network, which means they have not signed on to any contract with a dental insurance provider. As a result, the rates they charge for dental services are not pre-established. However, by being out-of-network, you can choose the dentist you want, rather than who your dental insurance allows you. Keep in mind that out-of-network practices will still take dental insurance, but you’ll need to be responsible for paying the difference between your coverage and what the dentist charges.
Along with the percentage of coverage being lower overall when out-of-network, the fees at out-of-network dental offices tend to be higher since they are not subject to any fixed price. It also means you’ll need to pay more out-of-pocket in most cases as well as pay immediately after the service is complete. However, it also means you can gain access to a much wider array of treatment options since the dentist is not restricted by the terms of a plan.
What to Keep in Mind Going Forward
Keep in mind that whether you choose to visit and in-network or out-of-network dentist, it’s essential that you make time to maximize your benefits before the end of the year. This is even more important when visiting a dentist that is in-network with your plan because you could be getting the best deal possible for your most important services.
For most dental plans, the allotted benefits will reset at the end of every calendar year and will not roll over. Any leftover coverage won’t be refunded either, so it’s best to schedule a visit now if you still have benefits to use.
Don’t wait another day to schedule a checkup with a dentist before the end of the year!
About the Author
Dr. Andrew Kung is in-network with dozens of dental insurance providers, meaning if you have a dental plan and benefits to use, there’s a good chance he accepts it! His knowledgeable team members are more than ready to help you maximize your plan to the fullest, so don’t wait to give his office a call and start making the most of your insurance while you have time left in the year. To schedule an appointment, you can contact him through his website.
