Saturday, August 13, 2022

What Does In Network Mean With Dental Insurance

Don't Miss

How Much Is Dental Insurance

What does In-network mean for dental insurance?

The cost to have dental insurance varies based on your coverage, where you live, and other factors such as:

  • Is it an individual or family policy?
  • Is the dental insurance provided through an employer?
  • What are the annual maximums?
  • What are the annual deductible and the copays?

Affordable dental insurance plans might pay for preventive care but not pay as high of a percentage for major services. If you need thousands of dollars of work done for crowns or a bridge, a higher-cost dental plan might pay for itself.

Overall, monthly premiums range between $39 per month for an individual to $139 per month for a family . FAIR Health has a handy calculator for dental costs, which you can use to estimate the cost of specific dental services.

Ppo Network Dentist Insights

If you have a dental PPO plan, you may be able to receive partial coverage even if you visit an out-of-network dentist. But more often than not, you still may be able to enjoy the most savings by visiting an in-network dentist.

Visiting an in-network dentist can help you save money. We’ve compiled a list of resources to help you learn more about how to help reduce the cost of dental treatment and take good care of your smile.

Best Dental Insurance Plans With No Annual Maximum Of 2022

  • Number of Policy Types: 3
  • Number of States Available: 50
  • Providers In-Network: 500,000+

Physicians Mutual strikes an attractive deal with expanded coverage, no deductibles, and no waiting period for preventive care.

  • Coverage for more than 350 procedures

  • No deductibles

  • No waiting period for preventive care

  • 3-month waiting period for basic dental

  • 12-month waiting period for major dental

  • Limited coverage for some procedures

Physicians Mutual is our pick for the best overall dental insurance plan with no annual maximum because of its multifaceted coverage and no waiting period for preventive care. Coverage with Physicians Mutual starts at around $30 per month for its basic plan, which can include more than 350 procedures, including preventive care and more serious dental needs like crowns and dentures. Even better, there is no waiting period for preventive care, so you can get started right away on cleanings, X-rays, and routine exams.

There are no deductibles with a three-month waiting period for basic procedures, but after three months, coverage kicks in for cavity fillings, minor surgeries, sedation, and simple tooth extractions. There is a 12-month waiting period for major work, including root canals, crowns, dentures, and surgical tooth extractions.

You May Like: Does Car Insurance Cover Broken Window From Theft

Get The Right Health Insurance

The most important thing to remember when youre dealing with in-network and out-of-network charges is that the more you know about your plan and what it does and doesnt cover, the better off youll be. Stay in-network whenever you can.

To avoid surprises, we recommend working with a trusted insurance agent who is part of our Endorsed Local Providers program. Our ELP independent agents will be able to explain exactly what your options are, and which plan covers what charges. They can also shop around for you to find the best premium price.

About the author

Ramsey Solutions

Ramsey Solutions has been committed to helping people regain control of their money, build wealth, grow their leadership skills, and enhance their lives through personal development since 1992. Millions of people have used our financial advice through 22 books published by Ramsey Press, as well as two syndicated radio shows and 10 podcasts, which have over 17 million weekly listeners.Learn More.

What Types Of Plans Allow Me To See An Out Of Network Dentist

Delta Dental of Arizona Blog: In

One of the best ways to gain access to see any dentist is to find a PPO dental plan that pays a larger Out of Network payment to dentists.

These dental plans are sometimes classified as full coverage plans, Open Choice, Open Access or Indemnity plans because they will typically pay a UCR type of payment for Out of Network providers. Some plans pay up to the 80th percentile UCR or higher which typically means that 8 out of 10 dentists in an area will charge that amount for a given procedure.

With these higher reimbursement amounts, it becomes less likely that a dentist will want to balance bill a member for additional charges. And even if they do bill for other charges, it should be a smaller amount.

Therefore with full coverage or PPO dental plans, you can get the best of both worlds. You can elect to see an In Network dentist and take advantage of the discounted savings or you can see an Out of Network dentist that may provide the convenience and amenities that you seek.

Read Also: American Income Life Complaints

Does Do You Take My Insurance Equal Are You In

Do you think the above means the same thing? Most patients do. But it really does not. When you call a dental office and ask, Do you take my insurance? without asking any additional questions, almost 100% of the time they will say Yes. But are you and that office agreeing on what that means?

Lets define some things. Taking insurance just means that the dental office will file a claim to your insurance on your behalf. They are free to charge what they want and what is not covered by your insurance, you pay. They are not tied to any fees dictated by the insurance company.

What does in-network mean? It means that your insurance company has already negotiated the fees on your behalf and that is all the dental office can charge. Usually, this means its more affordable for you. I say usually because there are some shenanigans that offices pull in order to charge you more than necessary but thats for another article. But generally, you pay less.

So, was the office you went to lying when they said they took your insurance but after a few visits you realize that they were not in-network? No. But it might be a good public relations move for these offices to explain the differences on the front end. In their defense, youre ultimately responsible for what plan you purchased. Dental offices are not obligated to walk you through your insurance plan. But we usually do it as a courtesy. Dental plans are incredibly confusing .

In Network Versus Out Of Network Coverage:

If you come to see us and you are Out-of-Network, it simply means that if there is a difference between OUR fee and the Allowable Fee set by your insurance, you are responsible for the difference. Our fees are based on Usual and Customary Rates for our area and are usually still within or very close to the Allowable Fees set by a lot of insurance companies who base benefits on the Usual and Customary Rates. For most patients using their Out-Of-Network benefits, for Preventive and Diagnostic Services there will often be either a $0 or very minimal out-of-pocket cost. A lot of our patients have out-of-pocket costs between $20 and $40, but still prefer to come to us due our great service, not to mention the Free Laughing Gas, for which many offices charge $80-$130 per visit!

If your insurance bases coverage off of a FEE SCHDULE, this means that they will pay the designated percentage of coverage for any given service up to the Fee that THEY ALLOW. The fees Allowed by plans using a fee schedule are usually much lower than the actual fees at our office or many other offices in the area. You should expect to have an out-of-pocket cost if you have an Insurance that pays off of a Fee Schedule.

Please keep in mind that there are thousands of different insurance plans with all different stipulations for services.

We check on your insurance coverage and submit your benefits on your behalf as a courtesy. You are still responsible for understanding and knowing your benefits.

Recommended Reading: State Farm Dog Health Insurance

How To Get Insurance To Cover Out

Surprisingly, there are still insurance plans that cover out-of-network care in some areas, but its far less common than it used to be.1 So, if your favorite doctor isnt part of your insurance carriers network and you dont want to change doctors, dont lose hope!

Here are your options for getting your insurance carrier to cover an out-of-network charge:

Finding A Dentist In Your Dental Network

What is an in-network provider for dental insurance?

Most dental insurance carriers have lists of in-network dentists in your area. If you dont know where to start, this is a great first step for finding a local dentist in your dental network.Delta Dental of Washington has a robust Find a Dentist tool available online. Using this tool, you can filter dentists by location, gender, languages spoken by the dentist and even attributes, like dentist endorsements. Its a great way to quickly find a dentist who meets your needs.

Connect with us

Delta Dental of Washington is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. © 2001 – 2022 Delta Dental of Washington.All rights reserved.

You May Like: Is American Income Life Insurance Legitimate

Best For Major Dental Work: Careington

Careington C500 Dental Savings Plan

  • Number of Policy Types: 4
  • Number of States Available: 49
  • Providers In-Network: 100,000+
  • Copays still required

Careington is prepared to help with your major dental work, offering discount dental plans with an upfront fee schedule that makes it easy to understand your coverage. There are no eligibility exclusions, although plans are not available in Vermont. Plans start at $8.95 per month or $89 per year with member savings of up to 60% off standard dental procedures.

In addition to overall affordability, Careingtons coverage is comprehensive, with no waiting period, and includes cosmetic services like braces, dentures, and teeth whitening. While orthodontic coverage includes braces, it provides only up to 20% off normal costs.

Careington also offers DialCare Teledentistry, which offers a new way to communicate with experienced and licensed dental providers. There is 24/7 support available 365 days a year via virtual consultations done over the phone or video chat. You can receive advice and even a diagnosis for everyday and urgent dental-related issues.

Dental Insurance: How Does It Work And Who Can You Trust

Many people mistakenly believe when they go to their dentist who is contracted with an insurance company, , the dentist represents the insurance company. Not True. Your dentist receives a fee schedule, the insurance companys fee schedule, at the time they contract. This gives the dentist a right to be advertised on the insurance companys list of in network providers. Being In Network dictates the maximum fee the dentist may charge for treatment procedures allowed by the insurance company.

Your dentist has NO relationship beyond this agreement with your insurance company! And remember , no dentist is obligated to determine benefit allowances, bill your insurance, or deal with the problems that may come up to collect from the insurance companyIn network or not! Except for the fact they want to get paid for services provided. Dealing with insurance is very time consuming and expensive for a dental clinic. It requires hiring full time insurance billing staff to ensure navigating through the complications and requirements involved with filing claims to collect from the insurance companies.

So you have insurance, and you go to the dentist here is generally how it will work:

What codes are covered can often have conditions attached to them that allow for denial of payment for all or part of what you think is covered, based on what information is provided at the time they call for eligibility and benefits for your plan.

Recommended Reading: Does Geico Cover Slashed Tires

What It Means To Find An In

We get a ton of great insurance questions at Bite Size but the main one is are you in network with my insurance plan? There are many benefits of seeing an in network provider for your dental care here is some information regarding what it means to be an in-network provider for dental plans to help you choose the provider than best fits your needs:

Being an in-network provider simply means the provider has a negotiated or contracted rate with a dental insurance company. An out of network provider does not have a contracted rate with the insurance which then means the individual will likely pay more out of pocket expenses. In-network providers have contracts with the insurance companies to provide members with pre-negotiated rates, which typically can mean they will pay less when seeing that provider when co-insurance is calculated, while out of network providers can not offer discounted rates which has people paying more out of their pocket.

For many people just having insurance benefits may be important, however having a provider that is in-network is what is beneficial to take advantage of your benefits. Insurance companies have information on hand for people who are interested in bringing themselves or their families to an in-network provider.

If you have questions regarding who is an in network provider with your dental plan, your insurance company is able to provide a complete list of providers to help you choose!

File A Formal Request

What does In

You can submit a formal request to your insurance carrier to ask for out-of-network coverage. Your primary care physician will typically send your request to the insurance company.

If the insurer denies your first request, dont give up. You usually have more than one chance to get your case reviewed.

If your request is denied a second time, federal or state law might require your health insurer to let you continue your appeal by contacting an independent, outside group. Your insurance companys website should have information about how you should follow the appeal process.

You May Like: Travelocity Trip Cancellation

How Does Dental Insurance Work

Dental insurance can pay for things like annual cleanings, minor oral health fixes, or big-dollar dental claims for crowns and bridges. In general, dental coverage is broken out by preventive, basic and major services:

  • Preventive dental care includes diagnostic and preventive services like regular oral exams, teeth cleaning, and x-rays. It may also include fluoride treatments and sealants . In many cases, dental plans include 100% of the cost of preventive care.
  • Basic dental care includes office visits, extractions, fillings, periodontal treatment , and root canals. Your insurance company might pay anywhere from 60 to 80% of the cost for these services, with you covering the rest of the cost. But if you’re paying a lower percentage of the costs, you may have a high-dollar copay.
  • Major dental care covers crowns, bridges, dentures, and inlays. Inlays are something between a filling and a crown: Your tooth might have extensive decay and need a more substantial filling, but it may not be in bad enough shape to require a crown. Meanwhile, crowns completely cover the tooth. Some dental insurance plans include root canals under “major” dental care, while others categorize them as “basic.” The cost of major dental care is higher, and most insurance plans cover about 50% of the fee.

There are two main types of dentail insurance plans:

What Is A Health Insurance Network

In simple terms, a health insurance network is a group of health care providers across multiple specialties who have signed an agreement with a health insurance company.

When you choose a health insurance plan, youll be given access to one of these health care provider networks. Make sure that the plan you chooseand the plans network of health care providerslines up with your particular health care needs.

Don’t Miss: Is American Income Life A Reputable Company

Whats The Difference Between In

6 Min Read | Mar 22, 2022

We’re not talking about In-N-Out Burger. Sorry.

And we’re not talking about computer networks either. Not sorry.

What we are talking about is the difference between in-network and out-of-network health insurance.

In-network just means that your health care provider signed an agreement with your health insurance carrier to accept a discounted rate. And out-of-network just means that theres no signed agreement in place.

But theres more you should know. Lets get started.

How To Find An In

What it means being an Out of Network Provider with Delta Dental Insurance at Emerson Dental

Most dental insurance companies provide easy access to lists of dentists in your area who are members of their network. You can usually find these on company websites or in written materials sent to you annually from the insurance company.

If you havent selected a plan yet, its a good idea to verify that an insurance provider has in-network dentists near your home or work in addition to verifying that plan premiums and out-of-pocket costs are within your budget. Take the time to investigate the network providers and see if you can find one that best suits the needs of you and your family.

Guardian Direct has a wide network of over 100,000 dentists, including specialists such as orthodontists and endodontists. If you have or are considering purchasing a plan from Guardian Direct, .

Once you have selected a network dentist, call their office to confirm that they are still under contract with the insurance company. It may save confusion and stress to verify that the dentist is still participating in the plan before you make an appointment.

Read Also: Can Medicaid Claim Life Insurance Proceeds

We Know Dental Insurance Terms Can Be Tricky To Understand We’ve Put Together This Handy Guide To Help You Understand Your Dental Insurance Coverage

Getting a handle on your dental insurance is step #1 to guarantee you get the maximum benefit from your dental coverage.

  • Read and review the benefits booklet for the fully detailed outline of all that is included in your dental benefits.
  • Register/sign in to your MySmile® account and click on Coverage overview for an easy-to-read overview of your plan’s features and benefits.
  • Benefit period
  • Reimbursement levels
  • Waiting period

To help you better understand these fundamentals of your dental coverage, here’s a brief explanation of each one:

Benefit PeriodEssentially, a benefit period is the length of time during which the benefit is paid. Your dental coverage has both a plan effective date, and an end date, and in most cases, the benefit period for your plan will be one year.So, if your effective date on your plan is January 1, 2020, and the end date is December 31, 2020, you will no longer have coverage as of December 31, 2020, unless you renew your plan before the end date.


These two terms may sound similar, but they are not exactly the same. Both are fees that the patient is responsible to pay for a portion of their dental treatments.

MaximumYour dental plan probably mentions two types of maximums: annual and lifetime.

Connect with us

More articles

Popular Articles