Dental insurance can help you save on essential dental care, but it works much differently than the medical insurance that you’re used to, so it can be somewhat difficult to navigate. One thing that can have an impact on your benefits is whether you choose an in-network or out-of-network dentist. Continue reading to learn about your options before your plan renews at the end of the calendar year.
What Types of Dental Insurance Plans Are There?
These are the two main types of dental insurance plans that patients have:
- Health Managed Organization (HMO): This type of plan offers dental care coverage for monthly or yearly fees. However, they provide coverage limited to providers that work in-network. This means that you will be given a list of local dentists to choose from who have established a contract with the insurance company to provide dental care at pre-established rates. If you go to a dentist who is not on this list, it will not be covered by your dental insurance plan, and you will be left responsible.
- Preferred Provider Organization (PPO): PPO plans offer coverage to insurers at reduced rates too, but you are able to choose any provider you’d like, whether they are in or out-of-network. If you choose an in-network dentist, you will receive care at pre-established rates, but if you choose an out-of-practice practitioner, a customary fee schedule will be established. You pay for the services you get and then file the claim to be reimbursed.
How Do In-Network Dentists Work?
When you go to an in-network dentist for your oral health needs, you will generally pay less at the time of service. In most cases, plans will cover 100% of preventive care, 80% of basic procedures, and 50% for more complex restorative procedures. You won’t have as much freedom when it comes to choosing a dentist, but you will pay fewer out-of-pocket fees, receive higher coverage and benefits at the time of treatment, and encounter lower overall prices.
How Do Out-of-Network Dentists Work?
As for PPO plans, your coverage from different treatments can range anywhere from 100% to 50% to 40% depending on your unique plan. These providers aren’t contracted with your insurance company, so they don’t have pre-established rates. A lot of the time, highly-trained dentists work out-of-network, but you will usually end up spending more out-of-pocket since you have to pay at the time of your service. The good news is that you can still file claims and have money reimbursed directly to you. It is up to you to weigh the pros and cons of seeing an out-of-network dentist so you can determine if it is the right option for you.
The year is coming to a close soon, there is no better time to take advantage of your benefits. Starting in January, all of your unused benefits will go to waste, and you will be left responsible for your annual deductible once again. Care for your smile and wallet by scheduling your next visit today!
About the Practice
At Claybrooke Dental of Gahanna, Dr. Brooke Buller and Dr. Clayton Odenweller are both graduates of The Ohio State University College of Dentistry and have many years of diverse experience. They are in-network with numerous popular dental insurance providers and are ready to help you maximize your benefits. For more information or to schedule an appointment, visit their website or call (614) 475-1874.