Whether you have an individual plan or one through your employer, dental insurance plays a crucial role in making caring for your teeth an obvious choice for your oral health and your wallet. However, depending on the details of your plan, you won’t have the same experience if you choose out-of-network care over an in-network dentist. With this in mind, here’s what you need to know about choosing a provider outside your plan’s network.
#1. There Are Financial Risks
One of the biggest advantages of dental insurance is that it makes the cost of caring for your teeth more affordable. And while “out-of-network” doesn’t necessarily mean “out-of-coverage,” there are a few financial risks involved, like:
You lose the health plan discount
When a dentist is in-network with your insurance carrier, it means they have an agreement of the rates they will charge for everything from preventive care to restorative services. On the other hand, when you go out-of-network, you’re not protected by the same discounted rates. So, you may end up getting charged too much for your care.
You can be balance-billed
In short, an out-of-network provider can bill you for whatever is left over after your insurance company pays its part. So, if your policy covers 50% of a $1,000 dental crown, you may expect to pay $500 out-of-pocket. In a balance-billed situation, your insurance may think the dental crown should only cost $700, so they only pay $350, leaving you responsible for $650.
#2. There May Be Quality of Care Issues
Before your insurance carrier accepts a dental practice into their network, they do extensive research. For example, they will check that the dentist’s license is in good standing and that the quality of care meets their high standards. If they don’t, they are dropped, which ensures practices continue to maintain exceptional care. Of course, out-of-network providers don’t go through the same process, which may affect the quality of care you receive.
#3. It Puts More Responsibility on You
Since your insurance carrier isn’t vetting the dentist and their practice beforehand, it places the responsibility on you. So, you’ll be accountable for researching the best care, requesting your medical records, taking diligent notes during your appointment, and negotiating your rate. In short, you’ll be doing much more than you would with an in-network provider.
Having dental insurance is one thing, but maximizing it to the fullest is another. Fortunately, opting for an in-network provider can help you utilize your benefits while simultaneously receiving the high-quality care you deserve.
About the Author
For over two full decades, Dr. Javier Perez has used his extensive education, clinical expertise, and genuine passion for dentistry to help his patients achieve pristine oral health. He and his team at Times Square Family Dental firmly believe that world-class care shouldn’t come with an astronomical price tag, which is why they welcome any and all dental insurance plans. If you have a question about your coverage or are looking for a dentist in Tyler, visit their website or give them a call at 903-534-8110.