In-Network Dentist vs. Out-of-Network Dentist: What’s the Difference?

If you have dental insurance, chances are that you’ve heard the terms “in-network” and “out-of-network” before. “HMO” and “PPO” may also sound familiar. However, you might be unclear as to what exactly they mean. It’s important to understand the difference if you want to get high-quality dental care and keep your smile healthy. Read on to learn the difference between visiting an in-network dentist and an out-of-network dentist, as well as how it impacts the caliber of your care.

Types of Dental Insurance Plans: HMO vs. PPO

Dental insurance is inherently complicated and difficult to use, so it helps to understand a few basics. First, you should find out whether your plan is a PPO (Preferred Provider Organization) or an HMO (Health Managed Organization).

With an HMO, you’ll only receive discounts on your care if you see a dentist who is in-network with your insurance company. In contrast, a PPO plan allows some of your care to be covered whether or not you visit an in-network dentist.

What Does It Mean for a Dentist to Be Out-of-Network?

An in-network dentist has signed a contract with an insurance company to charge established rates for certain services. However, the treatments they provide are often restricted by what the insurance company will cover.

Visiting an out-of-network dentist, on the other hand, doesn’t limit the type of care you can receive. In fact, this option is ideal for patients who need to undergo advanced procedures, like dental implants, without compromising on the quality of their treatment.

What Is a Fee-for-Service Dentist?

Just because a dentist isn’t in-network doesn’t mean you can’t save. In fact, because so many patients have invested in dental insurance, many out-of-network dentists are willing to file claims on your behalf. However, this typically comes in the form of reimbursement, so you’ll be responsible for payment at the time of treatment. This is called a fee-for-service dentist, and their team is happy to help you maximize your benefits by handling much of the paperwork for you.

Get High-Quality Care by Seeing an Out-of-Network Dentist

To get the top-quality dental care you deserve, consider seeing an out-of-network dentist. While you may need to pay out-of-pocket expenses up-front, you’ll most likely be reimbursed to some degree later. If you have a PPO dental plan, you’re free to choose a dentist who will deliver the perfect level of care that your smile needs.

About the Author

Dr. Ukti Phadnis is a dentist in Wethersfield, CT who enjoys nothing more than helping patients maintain bright, healthy smiles. While she isn’t in-network with any dental insurance plans, her team accepts virtually all PPO plans and can gladly help you maximize your benefits by handling the claims process on your behalf. To learn more about saving on high-quality dental care, contact Wethersfield Dental Group at 860-400-3007.