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In-Network vs. Out-of-Network Dentist: Which is Best?

October 25, 2023

Filed under: Uncategorized — wacofamilyteam @ 1:52 am

Dental insurance at a fingertipDid you know that 156 million Americans have dental insurance? However, less than 3% of adults meet or exceed their annual limits. Billions of dollars in unused dental insurance benefits are lost every year. You already pay for your coverage, so why not use it? Dental insurance is an investment in reduced costs for the services you need to keep your teeth and gums healthy. Your first step to a healthier smile is choosing a dentist that accepts your policy. Here’s what you need to know to choose between an in-network and an out-of-network dentist.

Benefits of an In-Network Dentist

Your dental insurance will recommend choosing an in-network dentist to reduce your out-of-pocket expenses. An in-network dentist has been vetted by your insurance company to ensure they maintain the highest standards when providing dental care. Your insurance has pre-negotiated rates with in-network practices for specific services, like cleanings and fillings. You’ll benefit from more coverage at the time of service. 

Your monthly premiums give you access to a nationwide network of dental professionals. You can benefit from 100% coverage for preventive care, like cleanings and checkups.

Your insurance will also pay some of the expenses of medically necessary procedures, like gum disease treatment, fillings, and root canals. After meeting your deductible, your insurance can pay 50% to 80% of the expenses until you hit your yearly limit.

Benefits of an Out-of-Network Dentist

Although your insurance company recommends a dentist in their network, you can visit any location that accepts your coverage. An out-of-network dentist can give you more freedom when choosing dental practices and services. 

You can still use your coverage, but your insurance may only pay 20% to 50% of the expenses. You’ll have to pay the difference between the dentist’s fees and your insurance’s allowable amount. Therefore, you may pay more out-of-pocket.

Use It Before You Lose It

Your dental insurance gives you the opportunity to keep your mouth healthy for minimal expenses. With your oral health and general wellness closely connected, a healthy smile is important.

Unfortunately, your dental benefits don’t last forever. They reset at the end of the year. You’ll lose anything you don’t use and nothing accumulates. You won’t be reimbursed for your premiums or deductibles. You could throw hundreds to thousands of dollars down the drain that could have been spent on keeping your mouth healthy.

There’s still time to maximize your benefits. Schedule an appointment with your dentist before the end of the year.

About Dr. Syria Dhaon

Dr. Dhaon earned her dental degree from Herman Ostrow School of Dentistry and has completed advanced training in prosthodontics, dental implants, and laser dentistry. She accepts many dental insurance plans, including Aetna, Cigna, and MetLife. Request an appointment through her website or call (254) 848-0240.

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