By Tim Fitzgerald on Apr 14, 2021 @ 11:00 AM
If you’ve ever called your dental insurance company about an unexpected dental bill and they asked you “was the dentist in-network or out-of-network” you might be wondering what that actually means – and if you should be finding a new dentist. Well, here’s what you need to know about the difference between in-network and out-of-network providers.
Your dental insurance benefits are dependent on your dental carrier having a network of dentists who have agreed to their procedure costs and accept their coverage. The dentists who participate in the network are called “in-network” dentists. These dentists accept your insurance and will provide you the most cost savings – and if you have a Dental HMO or EPO plan, they are the only dentists you can see and be covered.
But if you have a Dental PPO plan, you have the flexibility of out-of-network (OON) coverage. This means you can see out-of-network providers and your insurance will still cover you – just not as much. You’ll generally pay around 40% of the cost whereas if you stay in-network on your PPO plan, you may pay around 20%.
How Staying In-Network Helps You
But just because you can go out-of-network with a DPPO plan doesn’t mean it is the best option. Staying in network can save you a lot of headaches, here are a few ways:
- In-network providers generally agree to discounts on their services
- Between discounts and richer coverage amounts, save between 10-30 % on common procedures.
- No submitting claims forms to your insurance – the provider already has a relationship with them
Dental networks aren’t as complicated as they might seem – and knowing how they work can save you a lot of money and headache. So be sure you find a dentist who is in-network on your insurance plan. But knowing the difference between in-network and out-of-network is only the beginning. You also want to know your dental network is flexible and accommodating to your needs – especially if you have a DHMO or EPO plan. Check out our infographic below on Open-Access DHMO and EPO networks and how they can bring you big savings!