If you have a PPO dental insurance plan, you can visit virtually any dentist in the U.S. and use your benefits. However, your insurance still has a “network,” and whether you visit an in-network or out-of-network provider can affect your out-of-pocket financial obligation. How do dental insurance networks operate, and what can you do to get the greatest value out of your plan? This blog post contains useful information.
What Does It Mean to Be In-Network?
When a dentist is described as “in-network,” it means that the dental practice has agreed to a contract with your dental insurance company. This contract establishes specific rates for various procedures, which are typically lower than what you might pay without insurance or at an out-of-network practice. As a patient, you are allowed access to these negotiated rates when you choose an in-network provider.
Your insurance company compiles a list of dental practices that have accepted these terms. If you select a dentist from this list, you are considered to be receiving in-network care. While you may still be responsible for a portion of the cost, your insurer will help cover a predetermined percentage, and your out-of-pocket expenses are likely to be more predictable.
Important note: Being in-network is not the only factor to consider when choosing a dental practice. The quality of care, the dentist’s expertise, and the services offered should also guide your decision.
What Does It Mean to Be Out-of-Network?
An out-of-network dentist is a provider who does not have a formal agreement with your insurance company. This does not mean that your insurance cannot be used at all. In fact, most out-of-network providers will still file claims for patients and work with insurance companies to help you get the coverage you are entitled to.
While you may end up paying a bit more at an out-of-network provider, choosing one might have some advantages. For example, they may offer unique services, flexible appointment scheduling, or other important perks.
Tips for Maximizing Your Coverage
Regardless of which type of provider you choose, there are several strategies you can employ to help ensure you receive the most value from your dental insurance:
- Review your insurance plan documents thoroughly. Understand what procedures are covered, your annual maximum, and your deductible amount.
- Maintain regular checkups and cleanings. Preventive care is often covered at a higher rate by insurance plans, and staying proactive can help you avoid more costly procedures later. Since most insurance plans cover two cleanings and checkups every year, there is no reason not to stay on top of preventive services!
- Keep track of your benefit period. Most dental benefits do not roll over into the next calendar year, so use your coverage before it expires.
- Communicate with your dental provider about your financial concerns. Many offices will assist in clarifying your benefits, or they may offer financing options.
- If you are considering an out-of-network provider, ask for a detailed explanation of their financial policy. You should know when they expect payment, their normal fees for basic services, and their accepted forms of payment.
Your insurance network is not the most important aspect of your coverage, but it still deserves consideration!
Meet the Practice
At Transforming Smiles in Lawrenceville, our team welcomes insurance. We strive to provide top-quality care in a friendly environment, and we are happy to work with patients who have questions about our financial policies. To learn more about us and how we may be able to serve you, contact our office at 770-995-7616.