Is your dentist in-network or out-of-network?
There can be a big difference.
We've worked hard to build one of the nation's largest networks of participating dentists and there are many benefits to seeing a dentist who is in your network.
- Not a fan of paperwork? All of the dentists in our network will file claims on your behalf. Out-of-network dentists may ask you to complete and submit your own claim forms.
- Trying to spend less? Seeing an in-network dentist can also save you money. As part of our network agreement, we work with participating dentists to negotiate discounted fees for the services they provide. In-network dentists have agreed to accept these negotiated fees as full payment, but out-of-network dentists can set their own fees.
Here's an example:*
- Imagine you visit an in-network dentist for a crown. The standard fee is $1,000. But because your dentist is in-network, she charges our negotiated fee of $600. Since your plan covers crowns at 50% of the allowance - another term for that is discounted fee, we pay $300. You pay what's left, which is the other $300.
- Say you visit that same dentist, but in this imaginary situation, your dentist is out-of-network. Because the dentist is not obligated to honor our discount, you can be charged their standard fee of $1,000 for the crown. We still pay $300.00, and you still pay what's leftover, but this time, it's $700.00. This is called balance billing.
Things to remember
Keep in mind that how much money you'll save can depend on your plan:
- If you have a PPO Plan , you can visit any dentist and still have coverage, but you will save more money if you stay in-network.
- If you have a DHMO Plan, you must visit your assigned dentist in your plan's network to receive coverage. This type of plan does not cover out-of-network dentists, which means you would be responsible for paying everything out-of-pocket.
Find a network dentist
Our Find A Dentist tool shows you all of the nearby dentists who are in your plan's network. Every in-network dentist accepts our discounts for services covered by your plan, but many of them also accept these discounts for non-covered services - even after you've met your annual maximum.
* For illustrative purposes only. Savings shown do not account for premium cost. Savings will vary by dentist, service, patient history and geographic region. Sample charges based ZIP Code 15112 as of November 2016, and rounded up to even dollar amounts for ease of explanation.