Dental Insurance: Understanding In-Network vs. Out-of-Network Coverage

Deductibles, premiums, copayments, oh my! The language of the insurance world can be confusing at best and misleading at worst. But it shouldn’t stop you from receiving the care you need and deserve.

In this post, our team of dentists at Rifkin Dental takes a moment to walk you through the difference between in- and out-of-network insurance to help you get the most out of the benefits you’re paying for. 

What is a health insurance network?

Let’s start with the basics and define a health insurance network: a group of health care providers across multiple specialties that has signed an agreement with a certain health insurance company. 

When you choose a health insurance plan either through an employer or the open market, you receive access to one of these health care provider networks. That’s why it’s important to check that your chosen plan has the type of providers that fit your specific healthcare needs. 

What does in-network insurance mean?

When your provider is “in-network,” all that means is that they have signed an agreement with a certain network of healthcare providers. This can include doctors, hospitals, pharmacies, dentists, physician assistants, etc. 

To be accepted into the network, your provider has agreed to accept a lower cost for the services they provide. For example, a $100 service might only cost you $60. 

What does it mean if my dentist is out-of-network?

If an in-network provider can save you money, it may seem logical that an out-of-network provider would cost more. In some instances, that’s true, but dental care is a bit different from medical care. In almost every case, dental benefits for a dental cleaning or checkup are the same regardless of whether your insurance is in- or out-of-network. 

Instead of getting hung up on the insurance jargon, consider the following questions:

• What dental services do my benefits cover?
• How much does my insurer pay?
• What will I pay out-of-pocket?

We accept out-of-network insurance benefits, which means we can bill for and collect them. If you do have to pay out of pocket for a hygiene visit, it’s typically drawn from your deductible. 

If you require more extensive dental work beyond routine cleaning, it may be slightly more expensive. Many of our out-of-network patients are more than willing to pay a little extra for our higher standard of care. 

Don’t let the words “out of network” keep you from getting quality dental care. Make an appointment with us today and let us help you navigate your dental insurance benefits.