Why is my dentist Out of Network?


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

It’s becoming more common for many established dental offices to stop participating in any provider networks so they can charge higher amounts. These are often the “nice” offices that have soft cushy chairs and flat screen tv’s to watch while the dentist is working on you.

Newer dental offices will often participate with many networks as they seek to build a base of patients. But sometimes when an office decides that they have a full patient base they may elect to drop their network contracts as they move into being an established practice.

Most of these established offices will actually take or file insurance coverage but they haven’t agreed to accept the network payments and could choose to “balance bill” patients for charges in addition to a plan payment.

How Can I Use My Plan to See an Out of Network Dentist?

One of the best ways to gain access to these sought after dentists, while not paying too much is to find a full coverage dental plan with a larger Out of Network reimbursement. These plans are sometimes classified as 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 which typically means that 8 out of 10 dentists 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 Open Choice, Open Access or Indemnity plans, you can get the best of both worlds. You can elect to see In Network dentists and take advantage of the discounted savings or you can see Out of Network dentists that may provide the convenience and amenities that you seek.

At EasyDentalQuotes, we can help you find the right plan to meet your needs. Be sure to try our easy one step quotes to find plans in your area.

Try our “Easy One Step” dental quotes.


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