Many highly trained dentists choose to work outside the network. In other words, these dentists have no contract with any insurance company and do not have pre-set rates. The main benefit of choosing an out-of-network dentist is that you can choose the one that best suits your needs. 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. 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. Dental provider networks often go through cycles of dentist involvement. Newer dental offices often engage with many networks as they seek to build a patient base. But over time, when a dental office matures and grows to have a larger patient base, they may choose to cancel their network contracts as they become an established practice.
Out-of-network dentists are not subject to a limited fee schedule, so their prices are likely to be higher. However, because they may charge more, they are more likely to use higher quality materials and techniques. They may not be covered in the same way as with an in-network provider. The difference in the final price can be nil, partial or large.
Dentists in Delta Dental’s network also agree not to bill patients for differences between Delta Dental’s contracted charges and their typical charges. Nicholas Goetz and his team are excited about the opportunity to provide patients with the most advanced and comprehensive dentistry they deserve. 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.
When you value your oral health, you don’t want to choose a dentist from a very limited list of names. 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 a PPO, patients are provided with a list of “preferred dentists” who have chosen to offer their services at a reduced price. With 3 out of 4 dentists participating in Delta Dental’s network, it’s easy to find a qualified in-network dentist.
You can choose to see an in-network dentist and take advantage of discounted savings or you can see an out-of-network dentist who can provide you with the convenience and services you seek. So, even if the dentist you choose works out of network, you can still enjoy the benefits of the dental plan you’re looking for. Some plans pay up to the 80th percentile UCR or more, which usually means that 8 out of 10 dentists in an area will charge that amount for a given procedure. It is incredibly misleading to claim that only the best dentists can be hired with an insurance company.