In-network vs out-of-network – What it means for you

Every day, we get tons of phone calls asking the same thing: “are you in-network”? We answer with the same thing every time: “We are not in-network but we work with all insurances.” This frequently catches people off guard because they don’t actually know what a PPO plan is or how dental insurance truly works. They assume out-of-network equals zero insurance coverage. We can’t really blame them — dental insurance is a never-ending web of confusion and changing quotes. If we weren’t in this business, we probably wouldn’t know how dental insurance works either. It’s not like anyone typically “teaches” you these things — you’re just supposed to know somehow.

The problem is, because so many people don’t understand dental insurance, they make a lot of assumptions about what it covers, what it doesn’t cover, and where they should go to get the best coverage. We’re here to debunk all those myths and explain what exactly a non-contracted dentist means (and why we’re one!)

What is a PPO plan?

A PPO dental insurance plan is short for Preferred Provider Organizations. The name is sort of misleading because a PPO plan is the kind of plan that accepts both “preferred providers” (aka in-network offices) and non-preferred providers (aka out-of-network offices). If you have a PPO plan, which many people do, your insurance will most likely cover a portion of your treatment at an out-of-network provider (sometimes they cover out of network treatment exactly as they would for in network)

How do in-network discounts work?

In-network (aka “contracted dentists”) dentists sign contracts with dental insurance companies promising to charge pre-determined amounts for certain services. The pre-determined amounts are oftentimes significantly lower than what any office would normally be willing to charge. Why would a dentist be willing to charge so much less? Because the insurance companies swear that in-network dentists get more patients. In a perfect world, the increase in the volume of patients would make up for the lower cost of services (quantity over quality).

Of course, it doesn’t always work that way. The extreme discounts that contracted dentists have to give make it difficult for a dentist to deliver quality care and still be profitable.  A great example is dental labs. A lot of dental procedures require dental labs to make the necessary materials (like retainers, dentures, bridges, etc.) The price you pay at a non-contracted dentist covers that lab cost. At an in-network dentist, the office may have to absorb those lab costs. After a while of this, the dentist may decide to use a cheaper lab that doesn’t make as good of products but offers lower prices. Patients may get a cheap denture from their in-network dentist but because the office had to cut corners to make enough money, the denture probably won’t last.  Some offices will even buy lower quality materials to use in order to cut down on their spending to be able to remain profitable as an in-network dentist.  A lot of dentists move out of network for this very reason. They refuse to sacrifice on quality treatment for patients. With decreasing reimbursements from insurance companies and material costs increasing, becoming an out of network provider is the only option. Dr. Draper has never (and will never) cut corners or use lower quality materials for her patients in order to be profitable.

Another way in network dentists work to overcome the lower reimbursement rates from insurance companies is to book several patients at one time. This causes high wait times for you, and less individualized care from your doctor. At Draper Family and Cosmetic Dentistry, we do not double book or rush through appointments in order to increase profitability. 

Cheaper doesn’t equal better

This scenario applies to almost every aspect of dentistry. In-network dentists are constantly trying to stay afloat because a mazework of different contracts dictate their pricing. Unfortunately, the care in-network dentists are able to give can start to suffer because they have to make some serious sacrifices. This is why a lot of in-network dentists are switching to out-of-network. They realize that, as in-network providers, they would have to cut corners and that could negatively affect their patients’ dental health. After all, if you can’t give your patients the care they deserve then what’s the point of being a dentist?

Will I have to file my own insurance at an out-of-network dentist?

This is another big myth that our new patients come in with. There are very few, if any, out-of-network offices that force their patients to call and file their own insurance. Why? Because if you’ve never filed insurance before, you’re probably not going to do it correctly. As with most things dental insurance companies do, filing is a complicated process. In our office, we have a member of our team who does it all day. She knows the lingo and how to get it done efficiently and correctly. When you come in as a new patient, we’ll take a look at your insurance, explain your benefits and, after your appointment, file your insurance for you.

Aren’t the best dentists in-network?

Your insurance company might tell you that the best dentists in your area are in-network providers but, in truth, they have no idea about the credentials of the dentists they’re partnered with. The only qualifications they’re looking for are a dental license and a clean criminal record. They don’t care about how many hours of continuing education or how many fellowships the dentist has. There are so few dentists who are willing to stay in-network because it’s such an uncomfortable partnership.

I still want cheap dental work

We oftentimes give patients who are worried about prices the “car” talk. Dental work is an investment, just like a car is an investment. Everyone knows that if you buy an old, cheap car you’ll be in and out of the mechanic’s shop. This is because old cars need constant work. It’s a simple equation: the older the car, the more money you’ll have to pour into it down the line.

Dental work is the same way. If you go to a contracted dentist and get poor work done, you can’t expect it to last forever (or even a few years). You’ll pour more money into your dental health because the in-network dentist wasn’t able to deliver quality treatment during your first appointment. What seemed cheaper at the start often times ends up much more expensive than what an out-of-network dentist would’ve charged right off the bat.

Still not convinced? There are lots of people who don’t want to pay out-of-network prices and that’s okay. It’s just important to keep in mind that, in dentistry, the discount an in-network dentist gives can mean additional costs in a few years.

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