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How Do You Explain Out-Of-Network Dental Benefits?

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If you come to see us and you are “out of network”, it simply means that if there is a difference between OUR tariff and the allowable rate set by your insurance, you are responsible for the difference. If you decide to visit an out-of-network medical professional, you may pay more for services. Since out-of-network providers have not agreed on contracted rates with their insurance company, costs may be higher. Your insurance plan may also require a larger deductible and coinsurance payment for out-of-network care.

Out-of-network choices and reimbursement benefits are part of these PPO plans. This means that if you choose an out-of-network dentist who accepts your insurance plan, you can still receive coverage and benefits. Both the in-network and out-of-network dentists can work with insurance. As mentioned earlier, out of network doesn’t mean you can’t use your insurance.

It also doesn’t mean you won’t receive any benefits from your plan. In fact, most out-of-network dental offices accept insurance. Visiting an in-network dentist means less hassle and paperwork for you, saving you time and worry. When you choose a Delta Dental dentist, claims and any other paperwork will be filed on your behalf, and claims payments will be sent directly to the dentist in a convenient manner.

This means you don’t have to pay the entire bill upfront and then wait for the refund. You will simply receive an Explanation of Benefits (EOB) statement that describes what Delta Dental covered and what part of the bill may be your responsibility. Choosing an out-of-network professional means that you will have to pay for services at the time of treatment. If they are not in the network, ask your insurance company or benefits administrator how to get a list of current network providers.

The main benefit of opting for an out-of-network dentist is that you can choose the doctor you are most comfortable with. While they may seem confusing, it’s important to understand these dental insurance terms and definitions. If you would like to learn more about the difference between in-network and out-of-network providers, feel free to email or call the Rohrer Dental Wellness Center at. Knowing what PPO, HMO, or service charge means will help you make a well-informed decision when choosing your in-network or out-of-network dentist.

Cost estimates for services provided by out-of-network dentists (available in the out-of-network calculator) are based on claims data submitted for out-of-network providers. In-Network: A provider has signed a contract agreement with the insurance company to offer their insured patients a “discounted rate”. Now that you’re familiar with both of these dental insurance terms, review these tips to find the right dentist. When looking for a dentist, people usually have to decide whether to see a provider in or out of the network.

Delta Dental allows you to get the most value out of your insurance, with networks that include more than 155,000 dentists nationwide.


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