In-network dentists agree to contracted rates with your insurance, saving you money. Out-of-network dentists charge their regular fees with lower insurance reimbursement.
In-network savings average 20-40% due to negotiated rates. A $1,000 crown might cost $600-$800 in-network after the contracted discount.
PPO and indemnity plans allow out-of-network visits at higher cost. DHMO plans typically provide no coverage for out-of-network care except emergencies.
Insurance pays a percentage of UCR (usual, customary, reasonable) fees. If dentist charges more than UCR, you pay the difference plus your coinsurance.
UCR (Usual, Customary, Reasonable) is what insurers consider fair pricing. Out-of-network dentists charging above UCR leave you paying the excess amount.
In-network benefits: lower costs through negotiated rates, no balance billing above covered amounts, direct claims filing, and maximum coverage percentages.
Use your insurance company website provider search, mobile app, call member services, or check provider directories mailed with your plan materials.
Dentists can apply to join insurance networks. Ask your dentist if they would consider joining your network or if they have applications pending.
Balance billing is when out-of-network dentists bill you the difference between their charge and insurance payment. In-network dentists cannot balance bill.
Most PPO plans include out-of-network coverage at reduced rates (60-70% of UCR vs 80-100% in-network). Some restricted PPOs may limit out-of-network coverage.