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How Does My Dental Plan Work with an Out-of-Network Dentist?

man holding toothToday, more Americans than ever have dental insurance; however, one-third of adults don’t visit their dentist regularly. Often, people delay scheduling appointments because they worry about a large bill, but you have nothing to fear when using your insurance. You can get the affordable services you need for minimal out-of-pocket expense. It’s often recommended you visit a dentist who is in your network to make the most of your coverage, but you still have the freedom to visit one that’s out-of-network. Are you asking yourself, “how does my dental plan work if I’m out-of-network?” Here’s what you need to know to make the most of your benefits.

In-Network VS Out-of-Network Dentist

Your dental insurance will recommend you visit an in-network dentist for your oral health needs because they have pre-negotiated rates with one another. By paying your monthly premium, you can enjoy as much as 100% coverage for preventive treatments. Although every plan differs, most plans cover 80% of restorative treatments after paying your annual deductible until you reach your yearly limit when choosing an in-network dentist.

You can still choose an out-of-network dentist, but they aren’t contracted with your insurance company. You’ll need to pay the difference between the dentist’s fees and the insurance’s allowable coverage. You can choose any dentist who accepts your coverage, but the amount your insurance covers may vary. You may still have 100% coverage for preventive care, but they may only cover 50% of restorative services.

Using an Out-of-Network Dentist

You may want to consider an out-of-network dentist in you need a complex treatment and there isn’t a specialist in your network. Since you have the freedom to choose any dentist, you can look for one who is supported by the qualifications and training you need.

Whether in-network or out-of-network, you’ll enjoy reduced rates for the services your teeth and gums need to stay healthy. Your dental office will work on your behalf with your insurance company to file the necessary claims and paperwork for reimbursement. They will help you maximize your annual benefits to reduce the amount you need to pay out-of-pocket.

Maximize Your Dental Insurance

At the end of the year, your coverage expires. With less than 3% of Americans meeting or exceeding their annual benefits, you can lose all the money you’ve paid into your coverage if you don’t hit your limits. You will not be reimbursed for your premiums, deductibles, or allowance, and any unused funds won’t carry over into the new year.

If you need to see an out-of-network dentist, don’t wait until it’s too late. Schedule an appointment before your coverage expires at the end of the year.

About Dr. Greg Ritchie

For over 18 years, Dr. Ritchie has provided comprehensive, affordable dental care. He’s undergone advanced training in many areas of specialty, including sedation dentistry, dental implants, and cosmetic dentistry. These services can be costly, which is why he works with many leading insurance carriers to reduce the amount his patients pay for the services they need, even if they are out-of-network. Contact our office today to schedule an appointment to use your benefits before the year ends.


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