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Dental Insurance: Differences Between In-Network and Out-Of-Network Plans

An in-network insurance plan dentist is within the approved network of dentists for a particular dental plan. Out-of-network dentists are not on the list.

If you visit a dentist within the network, the amount you will be responsible for paying may be less than if you go to an out-of-network dentist.

In many cases, the insurance company will not pay anything for services your receive from outside their network; however, there are exception to this.

As a general rule, Dental PPOs, POSs, and DHMOs have provider networks. Indemnity plans typically do not have networks; you go to whatever dentist you want.

Can I buy dental insurance plan for less if I buy directly from the insurance company?

No. Insurance companies charge the same premium whether the dental insurance plan is purchased directly from the company, through a broker, or online.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Dental Fees

Fortunately, in these times, a lot of patients have dental insurance. Insurance is, on the face of it, a good thing. It minimizes out-of-pocket expenses for treatment and encourages people to keep up with the dental care they need. But most dental insurance plans do not pay 100%. There simply is no perfect insurance plan.

Part of the problem is what's called "usual and customary fees." Insurers have come up with a fee structure intended to reflect the "average" cost of "average" dental care. Urban residents may be allowed different compensation than people who live in rural areas. Reimbursement for a crown may be a certain percentage of the actual cost (the dentist's charge to you), and another percentage for a cleaning. Patients are sometimes puzzled at the discrepancy between insurer reimbursement and actual dental fees.

Of course your dentist can't dictate the amount your dental insurance plan decides is "average." And they don't ask your dentist what cost he or she thinks is fair. The dilemma is this: your dentist can't, in good conscience, recommend less than quality dentistry, even though your insurer may impose an unreasonable ceiling on treatment. It's a rock and a hard place.

For this reason, you should take objections directly to the insurer or compare dental plans with your employer. If enough people make enough noise, the reimbursement picture might improve.

Ask your dentist to sit down with you and go over your dental plan and your dental financing options. He or she will try to make your dental insurance plan work to your advantage. Your dentist cares about your finances, and your health.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.