Dental Insurance: Understanding In-Network vs. Out of Network Benefits

September 6, 2021

Filed under: News — elmbrookfamilydental @ 9:05 am
Person using phone to learn about dental insurance benefits

If you have dental insurance, you might be thinking about what you can do to take advantage of your policy before your benefits reset in 2022. One of the first things you should do is find a reliable, well-reputed dentist who is willing to accept payment from your insurance company. But how can you save the most? Does it matter whether you visit an in-network or out of network practice? Let’s talk about these important questions.

What Is a Dental Insurance Network?

A dental insurance policy’s network is a list of practices that have a contract with the insurance company. If you have an HMO or DHMO insurance plan, you can only use your benefits at in-network practices. Many people dislike such plans because they can prevent patients from visiting a dentist whom they trust and feel comfortable with.

If you have a PPO plan, you are free to visit any dentist. Whether or not they are in your plan’s network, you can expect to save on the price of your treatment. However, there may be some coverage differences between in-network and out of network practices.

In-Network Practices

If you visit a practice that is in your PPO plan’s network, you will probably pay as little out of pocket as possible. That’s because the dentist’s contract with your insurance company controls prices.

However, there are a few disadvantages to visiting in-network dentists:

  • Their contract might control some of the methods and materials they use for treatment, which can contribute to less-than-ideal care.
  • In-network dentists may take on quite a few patients so they can meet their financial goals. This might mean they are very busy and do not always have time to get to know patients one-on-one.

Out of Network

You may pay slightly more at an out of network practice. For example, if your plan covers 80% of the cost of fillings at an in-network practice, it might cover only 70% at out of network practices. Also, out of network dentists may charge more than what insurance companies deem to be reasonable and customary.

However, many patients prefer out of network dentists for a few reasons:

  • Out of network dentists are free to provide the care that they feel is best for patients, not the care that an insurance company tries to dictate.
  • Out of network dentists may be able to provide more personalized, comfortable care.

Which Is Better?

Whether you should visit an in-network or out of network dentist really depends on your priorities. You can save money and receive excellent care for your smile at either type of provider. If you are curious about how a particular dentist in your area works with insurance, give them a call. They will be happy to explain all of your payment options.

Meet the Practice

The talented dentists at Elmbrook Family Dental are pleased to provide a broad range of services for members of the Brookfield community. We accept payment from most PPO insurance plans, and we will be happy to help you navigate the ins and outs of your benefits. To learn more about our approach to dental insurance, contact us at 262-923-7075.

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