Although it’s designed to simplify your oral health care and save you money, understanding dental insurance can sometimes be difficult. With all the terminology and differences between plans, many people are confused about their coverage and how their policy works. If you’ve been curious about your own plan and wondering what the difference between in-network and out-of-network coverage is, keep reading for clarification!
In-network Vs. Out-of-network Insurance
Whether your dental insurance coverage is considered in network versus out-of-network depends on your dentist. Some dentists are considered in network, or “participating providers” with certain insurance companies because they have agreed to provide dental services to policyholders at pre-negotiated rates. With in-network, it’s important to note that you may still have a copay and deductible, depending on your plan.
Conversely, if you choose to go out-of-network, you can pick any dentist you want but because they’re not in-network with your dental insurance, you may pay more for your treatment. In most cases with a PPO plan, your coverage may range from 100 to 50 to 40 percent depending on your individual policy. Your up-front cost may also be higher because you may be required to pay for your treatment at the time of service, even though your insurance may reimburse you later.
Making the Most of Your Dental Insurance Benefits
With the end of the year approaching, now is the perfect time to use your remaining dental insurance benefits before they expire. Most plans can be adjusted during open enrollment, which typically begins in November, and new policies typically take effect on January 1. If you still haven’t had your regular preventive exam and cleaning, take advantage of your benefits and get your smile clean and bright before the new year!
About Dr. Parmar
Dr. Deval Parmar first earned her Bachelor of Dental Surgery (BDS) from MP Dental College in India, where she then ran her own successful dental practice before relocating to the United States. Once here, she earned her Doctor of Dental Surgery degree at Detroit Mercy School of Dentistry. She is an active member of both the American Dental Association and the Texas Dental Association.