Understanding Dental Insurance: In-Network vs Out of Network Coverage

November 20, 2020

Filed under: Uncategorized — drkalina @ 7:04 pm
Patient looking to use insurance at high-quality dentist in Mankato

If you have a PPO dental insurance plan, you are free to visit any virtually any dentist or dental specialist and still use your benefits. However, you may find that your insurance company urges you to visit “in-network” dentists. What exactly does that mean, and does it really matter if you visit an in-network or out of network care provider? A high-quality dentist in Mankato is here to answer these important questions.

In-Network Dentists

Dental insurance companies strive to establish contracts with dentists. The dentists agree to charge certain fees for services, which helps the insurance company save money. To encourage policyholders to visit an in-network dentist, insurance companies may offer a higher level of courage at these practices.

While visiting an in-network dentist may sound appealing due to lower fees, there are a few caveats to keep in mind:

  • Insurance companies may require that dentists use specific techniques, treatments or materials, which can lower the overall quality of care
  • Dentists who charge lower fees due to insurance contracts may try to squeeze more patients into their schedule. They may have less time to give you personalized attention.

Out of Network Dentists

Out of network dentists do not have any type of contract with your insurance company. However, most of them are still willing to file claims on your behalf and help you navigate your coverage. Additional benefits of visiting an out of network dentist include:

  • They can provide care in the way they feel is best, not in a way that an insurance company tries to dictate.
  • They may invest in better technology and comforts than in-network dentists, and they may have more time to spend with each patient.

Also, keep in mind that out of network dentists often have other provisions to help patients afford care. For example, they might have an in-house membership plan or accept financing from lenders that offer low-interest payment plans.

Using Your Benefits

Regardless of whether you visit an in-network or out of network dentist, remember that there is a time limit on your benefits. PPO plans typically give you an annual maximum, a pre-set amount that your insurance company is willing to pay out for approved services. At the end of the year, any unused portion of that maximum may expire. Hence, it may be in your best interests to schedule any necessary treatment now — before your 2020 benefits disappear and you end up losing out on hundreds of dollars’ worth of benefits. 

Are you using your dental insurance in a way that saves you money and allows you to take advantage of the best oral healthcare in your area? Choosing an out of network dentist may be the best way to accomplish that.

Meet the Practice

Dr. James Kalina is a dentist in Mankato who is committed to providing the best possible care to his patients. His team is happy to answer patients’ questions about insurance and file claims on their behalf. To learn more about Dr. Kalina and our practice’s policies, contact us at 507-625-2021.

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