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Dental Insurance: Differences Between In-Network and Out-Of-Network Plans

An in-network insurance plan dentist is within the approved network of dentists for a particular dental plan. Out-of-network dentists are not on the list.

If you visit a dentist within the network, the amount you will be responsible for paying may be less than if you go to an out-of-network dentist.

In many cases, the insurance company will not pay anything for services your receive from outside their network; however, there are exception to this.

As a general rule, Dental PPOs, POSs, and DHMOs have provider networks. Indemnity plans typically do not have networks; you go to whatever dentist you want.

Can I buy dental insurance plan for less if I buy directly from the insurance company?

No. Insurance companies charge the same premium whether the dental insurance plan is purchased directly from the company, through a broker, or online.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Know About a Dental Plan Before You Buy Insurance Coverage

Everyone seems to want a dental plan, but many dental patients don’t fully understand what it can do for them. The following information is intended to provide an overview of dental insurance, the variations that exist and how to effectively use your dental plan coverage and benefits. Also be sure to ask your employer if they have a discount dental plan.

Dental insurance is most commonly found as an employee benefit that helps the member and his or her family to afford proper dental care services. While dental insurance plans for individuals are sold, they are often quite expensive due to the elective nature of most dental services. Employers and their human resource managers purchase most dental plans for the company’s employees.

Dental plan and medical insurance programs are quite different in their coverage and their philosophy. A dental insurance plan is designed to support preventive care the helps the patient to avoid major dental expenses, while medical insurance programs are designed to provide extensive coverage for major illness and diseases, but little or no coverage for preventive services.

A similar medical insurance plan would have nearly complete coverage for preventive and diagnostic services, but lower coverage for a life-threatening illness that kept the patient in the hospital for an extended period of time.

The coverage levels in a dental plan are generally expressed as a series of three numbers, for instance - 100 / 80 / 50 - which represents the percentages of coverage for Preventive and Diagnostic services, Basic Restorative services (simple fillings) and Major Services (crowns, bridges and dentures). For a significant dental treatment plan, the majority of the cost will be borne by the patient because of the 50% coverage and annual maximum benefits that may be as low as $1500. Be sure to look for affordable discount dental plans.

The method of payment for dental insurance plans is referred to as fee-for-service. That is, the dentist charges a separate fee for each service rendered and the charges are submitted to the insurance company on a claim. Traditionally, those claims were paper claims that were mailed to the insurance company, but today many of the claims are being sent electronically from the dentist’s computer to the insurance company’s computer and then paid electronically back to the dentist.

It is important to remember that dental services are nearly always elective. Most patients do not have any life-threatening dental issues. Despite the fact that dental disease can be painful, the risk of death or serious consequences from a dental problem is very low. While the pain could make the situation very urgent for the patient, once the pain is relieved, the subsequent treatment can be performed quickly or slowly depending upon the expectations of the patient and the availability of the dentist and your dental plan coverage.

by Dr. Fred Sharpe

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.