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What Does it Mean when a Dentist is “In-Network?”

November 8, 2023

Filed under: Uncategorized — drayer @ 9:36 am
Patient talking to a dentist

Navigating the wide world of dental insurance can be difficult, and it involves sifting through a lot of jargon that you may not encounter in any other context.

For example, the difference between an in-network and out-of-network dentist may not be immediately apparent, not least because dental practices themselves don’t always use these terms to describe themselves. In the interest of helping you get the most out of your benefits, here’s what you should know about the distinction between these two kinds of providers.

What “Network” Are We Talking About Here?

Insurance companies don’t just reimburse you for the cost of care; they also negotiate with individual practices about the price of their procedures. Insurance companies have thousands of clients, and getting their seal of approval, i.e., being in their “network,” can draw in many potential patients. For this reason, insurance companies are often able to negotiate lower prices for their clients than what you would get on your own.

What is “In-Network?” What is “Out-of-Network?”

This is where the core distinction between in-network and out-of-network dentist lies. A dentist is in-network with your insurance plan if they’ve agreed to charge a lower, agreed upon price for care to their enrollees. They sometimes call themselves “participating providers,” indicating that they’ve accepted this kind of deal.

On the other hand, a dentist is out-of-network for you if they are not contracted with your insurance company in this way. It’s worth noting that most of these practices will still accept insurance, though getting the money from them will be a bit more involved—you’ll usually have to pay for care upfront then get reimbursed later by your plan. For this reason, out-of-network dentists sometimes call themselves “fee-for-service” practices.

Picking Between In-Network and Out-of-Network

All things being equal, going to a dentist that’s in-network with your insurance plan is obviously ideal. You’ll likely pay less and getting reimbursed by your dental plan will be easier.

However, in some situations you don’t want a cheap dentist—you want the best dentist. In the case of major, risky procedures you may want to pick an out-of-network dentist you can trust versus picking someone from a list. And of course, whether a dentist is in-network is irrelevant if the care you’re getting is unlikely to be covered anyway, as in the case of cosmetic procedures.

Ultimately, the answer to which kind of dentist you should pick comes down to your unique circumstances. Hopefully, however, you’re now a little bit better-equipped to make that decision.

About the Author

Dr. Dennis Ayer is a dentist with extensive clinical expertise and who cares deeply about the health of his patients. With his wealth of experience, clinical knowledge, and impeccable chairside manner, he’s proud to offer care that’s second-to-none. Dr. Ayer received his dental degree from the University of Missouri-Kansas City School of Dentistry, and since then has completed well over 3,500 hours of advanced education in a variety of dental fields.
If you have any questions about dental insurance, he can be reached at his website or by phone at (913) 246-3000.

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