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

June 4, 2024 |read icon 4 min read
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This overview will help clarify these options so you can make informed decisions about your dental care.

What does in-network mean?

In-network refers to providers or health professionals contracted with your dental insurance company to provide services at predetermined rates. These rates are usually lower than you might pay out-of-pocket, significantly reducing costs. Network dentists offer more significant cost savings and are generally held to higher standards through credentialing and quality management programs, ensuring a high level of care. Additionally, they typically handle all claims submissions and related paperwork, simplifying the process for you.

Before scheduling dental work, verify that the provider is part of your plan’s network. You can request a current list of network providers from your insurance company to ensure you are making informed choices.

The importance of out-of-network awareness

Opting for out-of-network dental services means choosing providers who have not agreed to your dental insurance plan’s contracted rates. As a result, these services are generally more costly, and the insurance plan typically covers a lesser percentage of these higher charges. This often leads to a greater risk of balance billing and higher out-of-pocket expenses. Not only might you pay more at the time of service, but you also risk hitting the annual plan maximum much more quickly, potentially limiting access to further needed care within the same year.

Understanding the financial implications of choosing an out-of-network dental provider is essential to manage dental care costs effectively. It is always recommended to check whether providers are in-network to minimize expenses and maximize insurance benefits.

Why check your coverage regularly?

Even if a provider is in-network, not all procedures may be covered under your plan. Always verify coverage with your insurance company before proceeding with any treatment to avoid unexpected costs. Additionally, reviewing your plan’s details for deductibles and coinsurance requirements is essential, especially since most dental plans offer preventive care coverage.

Enhancing Your Dental Insurance Knowledge

Learning more about your dental plan and tools can lead to more accessible benefits and manageable expenses. Ameritas members can access benefits information through their member account or in the Ameritas Benefits app. Review your plan details regularly and consult your insurance provider to clarify any uncertainties. To assist in estimating potential costs, you can use the Ameritas Dental Cost Estimator, which provides detailed insights into what you might expect to pay for various services.

By keeping these guidelines in mind, you can make informed decisions about your dental care and ensure you fully leverage the benefits available. Now that you know these two dental insurance terms and additional tools, review tips here to help find the right dentist.

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