You’re searching for a dental practice and find one you really like, with a caring team and a dentist with the right credentials, only to discover it’s out of network. For many people, “out of network” means they need to go somewhere else. They assume their insurance won’t pay anything or that seeing an out-of-network dentist simply isn’t an option. That is not necessarily the case. Understanding what out of network really means can help you make a more informed decision about your dental care and insurance benefits.
What Does “Out of Network” Mean?
Dental insurance companies establish networks of participating providers. An in-network dentist has a contract with your insurance company and agrees to its negotiated fees and other contractual requirements. An out-of-network provider has not entered into that particular contract. That doesn’t necessarily mean the provider doesn’t work with dental insurance. It also doesn’t automatically mean your plan provides no benefits there.
Many dental preferred provider organizations (PPOs) include benefits for in-network and out-of-network care, although the amount the plan pays and the out-of-pocket costs may differ. That’s why understanding your individual plan matters.
Insurance Is Only Part of the Decision
Dental benefits are valuable, and we understand that cost matters, but don’t conflate an insurance company’s network with a list of dentists best suited to your needs. You may choose a dental practice because you trust the dentist. Perhaps you value a more personalized relationship, want access to particular technology or services, or appreciate having time to discuss your concerns and treatment options. You may also be considering complex or long-term treatment and feel strongly about who provides that care. Those considerations don’t disappear just because a provider isn’t in an insurance network.
An Out-of-Network Provider May Be the Best Choice
Being out of network gives you more autonomy in treatment planning. An out-of-network practice is not bound by the same contractual limitations established between an insurance company and its participating providers. That gives your dentist more independence when recommending care based on your individual circumstances.
At Kissimmee Family Dentistry, we believe treatment planning should begin with your oral health, your concerns, and your goals. From there, we can discuss your options and help you understand the financial side of the plan.
Ask Questions Before Making a Decision
If you’re considering an out-of-network provider, ask your dental insurance company whether your plan includes out-of-network benefits, how those benefits are calculated, whether your deductible changes, and how much the plan contributes toward the treatment you’re considering. You can also ask the dental practice for an estimate of your expected costs.
For treatment that requires a larger investment, financing can be a convenient option. At Kissimmee Family Dentistry, we offer financing through CareCredit, LendingClub, and Cherry, as well as an in-office dental membership plan for patients without dental benefits.
Your Dental Plan and Your Dental Care Are Not the Same Thing
Dental insurance is a financial benefit. Your treatment plan is a healthcare decision. Ideally, the two work well together, but when choosing a dentist or deciding how to address a dental problem, it can be helpful to look beyond whether a name appears on an insurance company’s list. Consider the quality of the relationship, how clearly your options are explained, whether you feel heard, the dentist’s experience, and whether you feel confident in the care being recommended.
If you’re interested in receiving care at Kissimmee Family Dentistry but are concerned because we’re out of network with your dental plan, talk to us before assuming you can’t visit our practice. Our team can help you better understand your benefits, expected costs, and available financial options so you can make an informed decision about your care.
You can read more on our financial information page, but we’re always happy to answer your questions. Schedule an appointment at Kissimmee Family Dentistry, located in Kissimmee, FL, and let’s talk about what makes sense for your smile, your priorities, and your budget.