In-Network Providers vs. Out of Network Providers

In-Network Providers vs. Out of Network Providers Photo

If you have dental insurance, you're likely familiar with the concept of in network and out of network. But do you know the real differences between the two?

Let us give you a little run down on dental insurance and how it works. Dental insurance plans don’t work the same way that medical insurance plans do. In fact, they’re the complete opposite.

As the patient, you (or your employer) pay a monthly premium. In return, you get a dental policy that has an annual maximum ranging from $1000 to $2000. Most dental benefit plans have a deductible (around $50 or $100) to meet before benefits can are paid. After your annual maximum has is used, you are out of benefits for the year. Any treatment needed from that point on is an out of pocket expense. This is true whether your provider is in network or out of network.

Now let’s go over the difference between in-network and out of network providers.

In-Network Providers

An in-network provider has signed a contract with the dental insurance company. As a part of this contract, the provider agrees to provide services to patients at a discounted rate. The insurance company chooses the rates depending upon the type of benefit plan. The contract can limit the treatment that a patient can receive.

Out of Network Providers

Out of network providers do not hold a contract with the dental insurance company. This means that they do not have pre-established rates. The provider uses one fee for all patients, regardless of their insurance plan. If a provider is out of network, this does not mean that you won’t receive any benefits.

Using Your Benefits with an Out of Network Provider

If a provider is out of network, it does not mean that you will be unable to use your insurance benefits. Most out of network providers will assist with submitting claims on your behalf. For questions about your specific out of network coverage, contact your insurance company. Keep in mind that some dental benefit plans do not allow for out of network visits.

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