When it comes to understanding dental insurance, some various terms and conditions require thorough explanation, especially in-network versus out-of-network coverage. Knowing the difference can mean saving big on various services or paying more out of pocket. To avoid high-dollar treatment that requires you to dip into your savings, learn more about the pros and cons of each and why so many dental insurance companies and dentists recommend seeking in-network coverage.
In-Network vs. Out-of-Network: Why Does It Matter?
When reviewing your dental insurance policy, you’ll find that there are two different options when it comes to coverage – in-network or out-of-network.
In-network refers to the benefits you will receive when you choose a dentist who has an established partnership with your dental insurance company. While this means that your options for who you can see may be more limited, you will spend less on preventive and restorative services because of the negotiated terms and fees established between the dentist and the insurance company.
Out-of-network refers to coverage that you can expect when choosing someone who is not contracted with your insurer. Because they do not have an agreement with your dentist, you’ll be required to pay more out of pocket for the services you receive. Your dental team can still file a claim to determine if you will receive reimbursement, but you’ll be expected to pay for treatment upfront.
Why is In-Network Best?
Although you have the option to see any dentist you like, you must be okay with paying out of pocket if they are not in-network with your dental insurance company. This is often a deterrent for many individuals, especially those who rely on valuable savings offered through their plan.
Most insurance companies build their policies to last a single calendar year, meaning that all available benefits expire at the end of 12 months. If any remaining funds are not used, the money is returned to the insurance company.
By choosing an in-network professional to take care of your oral healthcare needs, you get the chance to save more money in the long run. How?
Apart from most (not all) insurance companies offering 80-100% coverage for preventive services, they also may provide 50-80% coverage for minor or major restorative services. This reduces the price you pay out of pocket, leaving the majority of the bill for your insurance to pay.
But this is only possible if you meet your deductible and agree to see an in-network dentist. If you wait to undergo a more complex procedure until next year, you will be required to meet your deductible again before your insurance company will agree to pay more.
It’s in your best interest to pursue high-quality, affordable oral healthcare from a dentist who is in-network with your insurance plan. In doing so, you’ll enjoy a healthier smile without having to break the bank.
About the Author
Dr. Eric Tolliver is a Springfield native who appreciates the opportunity to care for his neighbor’s oral healthcare needs. Graduating from the University of Missouri-Kansas City with his Doctor of Dental Surgery, he serves as the lead dentist at Galleria Dental of Springfield. When patients arrive looking for high-quality, affordable dental care, he and his team are here to go above and beyond. As an in-network dentist with many insurance plans, he looks forward to helping patients save. Contact us at (417) 887-5757 to find out what we can do for you.