Why is my dentist Out of Network?

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Why doesn’t my dentist participate in any provider networks? And how I find a plan they’ll take?

If you’ve found out that your dentist is an Out of Network provider, then you’re not alone. It’s becoming more common for many established dental offices to stop participating in any provider networks due to the lower negotiated fees required to participate in dental networks.

These are often the “nice” dental offices that have soft leather chairs and flat screen tv’s to watch while the dentist is working on you. It’s the kind of dental office that most people want to visit. Let’s take a brief look at the reasons for Out of Network dentists and how you can get the best dental benefits to see any dentist.

Why do dentists drop out of provider networks?

Dental provider networks usually go through cycles of dentist participation. Newer dental offices will often participate with many networks as they seek to build a base of patients. But over time when a dental practice matures and grows to have a larger patient base, they may elect to drop their network contracts as they move into being an established practice.

Fortunately for patients, most of these established offices will actually take or file insurance coverage. However Out of Network dentists are not contractually obligated to accept the lower network payments. Thus they could choose to “balance bill” patients for charges in addition to a dental plan’s payment.

For example, if a dentist usually gets $100 for a certain procedure and the dental plan pays $80, then they could choose to bill you the $20 difference. You can always ask a dental office if they balance bill for charges before you have services performed at their office.

What types of plans allow me to see an Out of Network dentist?

One of the best ways to gain access to see any dentist is to find a PPO dental plan that pays a larger Out of Network payment to dentists.

These dental plans are sometimes classified as full coverage plans, Open Choice, Open Access or Indemnity plans because they will typically pay a UCR (usual and customary) type of payment for Out of Network providers. Some plans pay up to the 80th percentile UCR or higher which typically means that 8 out of 10 dentists in an area will charge that amount for a given procedure.

With these higher reimbursement amounts, it becomes less likely that a dentist will want to “balance bill” a member for additional charges. And even if they do bill for other charges, it should be a smaller amount.

Therefore with full coverage or PPO dental plans, you can get the best of both worlds. You can elect to see an In Network dentist and take advantage of the discounted savings or you can see an Out of Network dentist that may provide the convenience and amenities that you seek.

How can I find a PPO plan to use at an Out of Network dentist?

Fortunately PPO plans are very popular with a large number of carrier options. You can access plan options online at sites like EasyDentalQuotes. We offer a variety of PPO dental plans with top carriers such as Delta Dental, Renaissance Dental, and others. The main thing is to be able to get the coverage you need in order to see the dentist of your choice.

So don’t get frustrated if your dentist is Out of Network. With a better understanding of provider networks and access to the right PPO dental plans, you can be sure to get the dental care you need without breaking the bank.


Find PPO dental plans to see any dentist

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