How to deal with an Out of Network dentist

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What if you didn’t know your dentist was Out of Network?

So you get a your dental bill in the mail and to your surprise, the balance is bigger than you expected. You dig a little deeper and look at your EOB from the insurance company. In the footnote is says… Out of Network provider. This is a shock because you were almost certain the dentist was In Network.

Unfortunately this is a common experience as many patients are surprised to learn that their dentist is now considered Out of Network. But don’t panic. There are some steps you can take to help reduce your existing dental bill and future dental expenses as well.

Explain your situation to the dental office

One of the first steps to take is to speak with your dentist office. Explain that you thought they were an In Network provider, but your Explanation of Benefits shows the claim was processed as Out of Network.

There can be a few reasons for this to happen. Occasionally there can be an error with the way the dentist files a claim. But sometimes the EOB is accurate and the dentist is now in fact, Out of Network. There are a few reasons why this can happen, and several things you can ask your dentist to do.

Dental network contracts expire if they are not renewed

Dental networks change all the time. Dentists typically contract with insurance companies to be an In Network provider, but those agreements expire after a period of time. Dentists are encouraged to renew their network contracts, but sometimes they don’t if they can’t come to an agreement of terms.

Unfortunately, some dental offices don’t advertise any change of network status, so patients can find out after the fact. If this happens to you, then you should ask for a few concessions.

Ask your dentist to “write off” any disallowed charges

If you have a dental claim that is processed as Out of Network, one of the first things you should ask your dentist is to write off any disallowed charges. These are amounts above what an insurance carrier has allowed for each procedure that was performed.

In Network dentists are required to write off disallowed charges, but Out of Network providers are not obligated to do so. However non-network providers can also agree to waive those charges as a courtesy to the patient.

Ask your dentist continue to treat you as an In Network patient

Sometimes if a dentist’s network contract expires, they will continue to treat those patients as though they were still In Network. This typically includes accepting the insurance payment in full and not balance billing the patient.

Insurance payments for Out of Network can vary depending on the insurance policy. Sometimes Out of Network payments can be lower or benefits could be reduced. If your network status has changed, you’ll want to make sure your dentist helps to reduce any negative effects.

Let your dentist know that you’ll seek a new In Network dentist

If you’re in a difficult Out of Network claim situation and the dental office won’t budge on the amounts they are charging, then you should threaten to go to another dentist in the area that is in your plan’s network.

Most dental offices fear losing patients as they are the life blood of their business. A good dental office will do whatever it takes to keep their patients happy and maintain them as a customer.

Just like any other service, your biggest power as a customer is the power to leave and shop somewhere else. The same applies to services like dental and medical care.

Avoid any future issues by keeping check of dental networks

As mentioned before, dental networks can frequently change. So it’s a good idea to frequently check your dental plan’s network to verify your dentist is still in good status with your dental carrier. It can be a good habit to check your network online before any upcoming scheduled dental work.

When you’re looking for current In Network providers in your area, you’ll sometimes find new dentists and practices that are added to your options. Whether it’s a better location or good reviews from friends or family, you may want to consider other provider options once you find out they are In Network for your dental plan.

You’ve got options when dealing with Out of Network dentists

So remember, if you’re dealing with an Out of Network dental claim, there are some basic steps you can take to help reduce your existing bill and avoid future charges. The key is good communication with your dental provider and keeping a check on the network status of your dentist.

With occasional online checks for network status, you can monitor how your dental network changes to be sure you’re using the best dentist available.


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