What Does In Network Mean for Dental Insurance and Choosing the Right Plan

Choosing the right dental insurance plan can be overwhelming, especially with all the jargon and technical terms. In-network providers are dentists and specialists who have a contract with your insurance company to offer discounted services.

You'll typically save money by visiting an in-network dentist, with some plans offering 20-50% off services. For example, a routine cleaning might cost $75 out-of-network, but just $40 in-network.

In-network providers usually have a limited list of dentists and specialists they work with, which can be a drawback if you have a preferred dentist. However, this can also be a benefit if you're looking for a specific type of care, like orthodontics or oral surgery.

Dental insurance is coverage that pays some of the costs associated with preventive, basic and some major dental care.

Having dental coverage can be a helpful way to manage dental care costs because it helps assure you'll have benefits to pay for some of the care you may need.

Dental insurance can pay for some of the costs associated with preventive care, such as regular check-ups and cleanings.

Dental insurance can also help pay for basic care, like fillings and extractions.

You'll often hear the terms "in network" and "out of network" when it comes to dental insurance, but what do they really mean? In network dentists have an agreement with your insurance company to honor a contracted price for procedures, which can save you money.

Your insurance company will file a claim on your behalf and handle the billing, making it more convenient for you. This is why it's essential to choose an in network dentist for your care needs.

The cost of procedures is significantly lower with in network dentists, as they are bound by the contracted price agreed upon with your insurance company. For example, a crown that costs $1,200 at an out of network office might only cost $750 with an in network office.

Insurance is a type of coverage that pays some of the costs associated with various types of care, including dental care.

Having insurance can be a helpful way to manage costs, as it can help ensure you have benefits to pay for some of the care you may need.

Dental insurance is a specific type of insurance that covers some of the costs associated with preventive, basic, and some major dental care.

You'll want to choose a dental insurance plan that fits your budget and meets your care needs. Consider the different payment levels of each plan, including premiums, deductibles, coinsurance, and copays.

UnitedHealthcare branded dental plans offer a range of options to suit various budgets, from budget-friendly plans covering the basics to more comprehensive plans covering more services. Take a close look at the payments required for each plan to decide which one works best for you.

If you have a PPO dental insurance, you have the flexibility to go to any dentist you want, but keep in mind that some may not be "in network" with your insurance company. This can affect the cost of your care, with "in network" prices typically lower than "out of network" prices.

DHMO plans tend to be more inexpensive, but they often come with the trade-off of being limited to a specific dentist or office. If you go to a dentist not assigned to you, the insurance company won't cover your visits, leaving you with the full cost of treatment.

Consider the importance of being able to choose your dentist, and whether the savings of a DHMO plan outweigh the flexibility of a PPO plan.

A dental network is a group of dentists under contract with your dental insurance carrier, agreeing to provide care at a set fee. These dentists are considered in-network.

In-network dentists often have agreed to accept greater network savings than out-of-network dentists. This means you'll typically pay less for services with an in-network provider.

To find in-network providers, try searching your insurance company's website or using an online healthcare platform. You can also check your healthcare provider's website to see if they participate with your insurance plan.

In-network benefits mean your insurance company is charged a lower negotiated price for service, and you're likely responsible for a copay and/or a percentage of the cost. This can save you money compared to out-of-network providers.

Out-of-network providers may charge higher fees, and you'll typically pay more for services. However, some insurance plans may have lower out-of-pocket costs for out-of-network services, especially for preventive and diagnostic services.

Finding a dentist in your dental network is a great first step when searching for a local dentist. Most dental insurance carriers have lists of in-network dentists in your area.

You can start by using your insurance company's website to find a list of providers operating in-network. Delta Dental of Washington has a robust Find a Dentist tool available online that allows you to filter dentists by location, gender, languages spoken, and more.

To ensure you're working with a qualified dentist, look for those who have updated their credentials and follow the latest best practice guidelines. Delta Dental updates its best practice guidelines every year to ensure its in-network dentists are using the most effective treatments and procedures.

An online healthcare platform can also be a useful resource for finding and booking in-network appointments with dentists. Just remember to verify the participating providers directly with your insurance company before scheduling a service.

If you're using out-of-network benefits, you'll often have minimal out-of-pocket costs for preventive and diagnostic services, sometimes even $0.

Out-of-network benefits can also mean you're not subject to downgrades for services, which can save you money in the long run.

Our office checks on your insurance coverage and submits your benefits on your behalf as a courtesy, but you're still responsible for understanding and knowing your benefits.

In some cases, out-of-network providers like our office may have fees that are higher than the allowable fees set by your insurance company, which means you'll be responsible for the difference.

Understanding your insurance coverage can be overwhelming, but it's essential to know what you're getting into.

If you're "Out-of-Network", you're responsible for the difference between our fee and the Allowable Fee set by your insurance.

Our fees are based on "Usual and Customary Rates" for our area, which are usually close to or within the Allowable Fees set by many insurance companies.

For most patients using their Out-Of-Network benefits, Preventive and Diagnostic Services often come with a $0 or 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 to our great service.

If your insurance bases coverage off of a FEE SCHEDULE, you should expect to have an out-of-pocket cost, sometimes sizable, for services.

This is because the fees "Allowed" by plans using a fee schedule are usually much lower than our actual fees.

Using Out-Of-Network benefits often means you're not subject to as much downgrading for services, unlike In-Network Providers.

Some insurance companies stipulate downgrades for certain procedures, such as crowns, and you're responsible for the difference.

You'll want to understand the basics of insurance terminology before diving into your policy options. If you're preparing for open enrollment, you've likely seen words like "claims", "deductibles", and "copay" at every turn.

A claim is the formal request to your insurance provider to pay for a covered expense. This can include medical bills, prescription medication, or other eligible costs.

A deductible is the amount you must pay out-of-pocket before your insurance kicks in. This can be a fixed dollar amount or a percentage of the total cost.

A copay is a fixed amount you pay for a specific service, like a doctor's visit or prescription.