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?

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” 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 most people want to visit.

With dental provider networks, they can sometimes 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 feels that they 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, but they haven’t agreed to accept the lower network payments. Thus they could choose to “balance bill” patients for charges in addition to a dental plan’s payment. So if a dentist usually gets $100 for a certain procedure and the dental plan pays them $80, then they could choose to bill you the $20 difference. You can always ask a dental office if they balance bill for charges.

What types of plans allow me 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 that pays a larger Out of Network payment to dentists. These plans are sometimes classified as PPO 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 Out of Network dentists 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?

At EasyDentalQuotes, we can help you find the right plan to meet your needs. We offer a variety of PPO dental plans with top carriers such as Delta Dental,   Renaissance Dental, and others. Be sure to try our one step quotes to find plans available in your area. At EasyDentalQuotes, we make dental insurance easy.

Try our “Easy One Step” dental quotes


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