In-Network vs. Out-of-Network Dental Insurance Coverage: What’s the Difference?

October 21, 2023

Filed under: Uncategorized — dr_bannan @ 7:32 pm
Filling out a dental insurance form on a laptop

One of the first things you will want to check when scheduling an appointment at a new dental practice is whether they take your dental insurance. But it’s not just a question of whether they’ll accept your plan; it’s also important to confirm whether the dentist is in-network or out-of-network with your current dental insurance provider. Here’s what you need to know about in-network and out-of-network coverage when it comes to paying for your dental care.

What is an In-Network Dentist?

If a dentist is in-network, that means they have entered a contractual agreement with your dental insurance company. Said agreement typically involves providing dental services at lower negotiated rates. As such, your out-of-pocket costs will generally be reduced, allowing you to get the care you need at a more affordable price. Additionally, if you choose an in-network dentist, you may be able to get 100% coverage for dental checkups and other forms of preventive dentistry.

What is an Out-of-Network Dentist?

If you have a PPO dental insurance plan, you have the option of choosing an out-of-network dentist. This means you have more freedom in selecting a practice that truly suits your needs while still being able to take advantage of your dental insurance benefits. Note that the level of coverage available when visiting an out-of-network dentist can vary depending on who your dental insurance provider is. It’s therefore important to review your plan carefully before you schedule any appointments.

Please note that an HMO dental insurance plan will not pay for treatments at an out-of-network provider at all. Therefore, patients with HMOs must stick to in-network dentists if they want to utilize their insurance benefits.

How Will You Know if a Dentist is In-Network or Out-of-Network?

The best way to know if a dentist is in-network or out-of-network with your dental insurance is to give their office a call. If you give the dental team your insurance information, they’ll be able to confirm whether the practice accepts your current plan and what you can expect your coverage to look like.

Even if a practice is out-of-network with your dental insurance, you could still potentially save a significant amount of money by using your benefits wisely. Let your dental team know if you have any questions about your insurance; they can go over the details with you and help you come up with a plan for getting the care your smile deserves without breaking the bank.

In short, it’s definitely worth figuring out whether a given dentist is in-network or out-of-network before you make any commitments. Make sure you’re as informed as possible when it comes to your dental insurance; your wallet and your smile will thank you later.

About the Author

Dr. Sean Bannan earned his Doctor of Dental Surgery at the University of Michigan School of Dentistry. He is dedicated to continuing his dental education so that he can use the latest techniques and treatments to help his patients maintain healthy, beautiful smiles. His Port Orange practice, Water’s Edge Dental, accepts a number of dental insurance plans. To schedule a consultation with Dr. Bannan, visit his website or call (386) 761-5883.