By Tim Fitzgerald on Nov 17, 2021 @ 10:00 AM
You went to the dentist, and the receptionist told you the office doesn’t take your insurance. It’s a rough moment – you’re caught between trying to pay for your care out of your own pocket or finding a new dentist. But why does this happen? Are there any ways around it? Here are four common reasons dentists stop taking dental insurance.
- Rosters: One of the common reasons dentists do not work with DHMO/EPO plans is rosters. Rosters are a method insurance carriers use to assign patients to dentists. The dentist is paid a monthly sum based on how many patients are on their roster. Many dentists don’t work with DHMO plans that have rosters since they have to maintain the roster monthly to be paid and their payout varies based on the patient count, not on the services they perform day to day.
- Claims Payouts: Another reason dentists do not accept certain carriers’ plans is claims Carriers will only cover a certain amount for each procedure, and if a dentist charges more than the covered amount, the patient pays the balance. This is balance billing. Since paying added costs after insurance is inconvenient for patients, many dentists try only to accept plans that match their costs.
- Medicaid: If you have Medicaid or Medicare, you may have already had difficulties finding a dentist that accepts your coverage. More dentists are opting not to accept Medicaid, with the top reasons being low claims payouts, the paperwork required by Medicaid for a claim, and high turnover and billing issues with Medicaid patients. If you have Medicaid, be sure to call and confirm your dentist accepts your coverage before your appointment.
- Accepts NO Insurance: Finally, some dentists choose not to accept any insurance. They may prefer to control their costs and decide their own pricing for services without worrying about insurance carriers, and instead have their patients use in-house or sponsored payment plans to make high-cost procedures accessible. If your dentist does not accept any insurance, make sure to ask ahead of time about payment plan options that will work for you and your budget.
What do you do if your dentist falls into one of the above categories and does not accept your insurance? Here are three tips to try to make the coverage options available to you work with your dentist.
- Consider a PPO plan for OON Benefits. If you can switch plans, a PPO plan will allow you to see providers outside the dental network. These out-of-network (OON) benefits can save you a lot of money annually if your dentist is OON. But keep in mind PPO plans come with deductibles and coinsurance you need to be aware of.
- Ask your provider why they don’t accept your insurance: If their reasons are related to rosters, claims, or other common DHMO issues, you might be covered if you switch to an open-access DHMO plan. Open-access networks don’t have rosters and use a basic fee-for-service payment model, making claims easier for dental offices. But be sure to check with your dentist to see what carriers they work with before switching!
- Find another dentist. This is a last resort, especially if you have a dentist your family is attached to. But if you cannot switch to a plan your dentist covers, or if your dentist is not accepting any insurance plans, it might be time to find a new provider. Check with your insurance carrier to find a new in-network provider. They should have a customer service line (you can find it on your dental insurance card) or a website/mobile app with a provider search feature!
Finding a dentist that works with your budget, your insurance, and the quality care you need can be a challenge. But it’s an even bigger challenge if you don’t have dental insurance that is right for you. To make sure you pick a dental insurance plan that’s the right fit, check out our FREE Dental Plan Selection Tool below!