Understanding Out-of-Network Benefits

Like health insurance, some types of dental insurance plans have in and out-of-network benefits. Those with dental insurance need to know about these types of benefits and how they will impact the cost of dental care. If your insurance covers only some of the dental services, you should also know about other ways to pay to make your dental treatment affordable.

Network Coverage for Dental Insurance

Dental plans with in and out-of-network benefits provide varying coverage levels. While visiting an in-network dentist gives you the best rates, you can still have some help paying for the cost of treatments offered by out-of-network dentists.

Types of Dental Insurance Plans

Dental insurance often falls under PPO or HMO plans. PPO plans typically have in and out-of-network benefits. However, they don’t pay as much for in-network coverage as HMOs.

HMO dental plans have smaller network coverage and often don’t pay for any treatments from dentists out of network. However, if you have this type of plan, you will likely have more insurance coverage for care provided by your in-network dentist.

Do Deductibles Count?

Some dental plans require you to meet a deductible before they pay out either in-network or out-of-network benefits. If you have a deductible, you must pay that amount out of pocket first before your insurance kicks in.

One great tip to remember is any year that you’ve met your deductible is a great time to schedule major dental work or treatments. For example, if you’ve met your deductible and need dentures, schedule the procedure the same year to ensure coverage from your insurance. If you put off getting your dentures until the following year, you must pay the deductible again before your insurance covers anything.

What Is In Network Coverage?

Dental insurance networks consist of groups of dentists who agree to accept lower payments from insurers for the perk of being in the network. For dentists, being in a network increases the chances of getting more patients from the insurer to come to their practice.

For an in-network dentist, they can charge a standard fee. However, the insurer will pay more for treatment than they will for an out-of-network dentist. For example, if the dentist’s typical cost is $500 for a service, the insurance company may arrange to pay $400 of that, leaving you to cover the remaining $100. Of course, the amount of coverage for in-network treatment depends on whether you’ve met your dental deductible.

What Are Out-of-Network Benefits?

Insurers pay less to out-of-network dentists than they do to that in-network. For instance, an out-of-network dentist who charges $500 may only have half of it covered under out-of-network benefits, meaning you pay the balance of $250.

You may not have any coverage for out-of-network dental care if you have not met your deductible. Contact your insurer for specifics of what they will cover if you want to get treatment from an out-of-network dentist.

How Much Do You Pay with Out-of-Network Benefits?

Out-of-network benefits will vary from paying a percentage of the care to not paying anything at all. Because insurance coverage changes so much and depends on your plan, how much you’ve spent toward your deductible, and whether your dentist is in or out of network, you need to talk to your dentist to determine what you will pay.

You can also ask our financial experts at Matthews Family Dentistry to see how much you’ll pay for treatment from us. We can help you get the maximum benefits from your insurance company to minimize your out-of-pocket costs.

Can You Still Go to an Out of Network Dentist?

Regardless of the type of insurance you have, you can still visit any dentist you want. The only difference is whether your insurance pays for any of the care you receive.

You may find an out-of-network dentist who has a team, technology, service, and level of care that you can’t find from in-network dentists. 

To get the most out of dental care, you should find a dentist you like going to, regardless of how much your insurance pays for their services. With a dentist you and your family know and trust, you’ll be more likely to keep your regularly scheduled visits for cleanings and exams, which reduces your chances of developing painful decay-related conditions that cost more, even with dental insurance.

Does Dental Insurance Cover All Dental Treatments?

Even with out-of-network benefits that pay a percentage of treatment, your dental insurance may not cover all dental services. Some dental plans may not cover cosmetic treatments, leaving you to pay the entire bill for whitening or Invisalign.

What Happens If You Still Need Help Paying for Dental Care?

Dentists offer many alternatives to dental insurance to reduce out-of-pocket costs, even if your insurance does not pay anything for out-of-network care. You will find flexible payment options and memberships at Matthews Family Dentistry.

One way we help our patients to pay for dental care at Matthews Family Dentistry is through our Membership Club. This plan lets you get discounted treatment for a low monthly fee. If you don’t have dental insurance or are out of network for your plan, this option can help you reduce your total costs.

We offer options to help you easily afford high-quality dental care from us at Matthews Family Dentistry.

Come See Us at Matthews Family Dentistry 

When you need dental care, visit Matthews Family Dentistry for dental services and payment options to meet your needs. Contact us to schedule a visit or to find out more about how you can pay for your treatment.