Are In-Network or Out-of-Network Dentists Better?

Do you know what it means to choose a dentist that’s in-network or out-of-network? When it comes to choosing a high-quality dentist in Mt. Dora, these are important terms to know when it comes to understanding your HMO or PPO dental insurance plan. Read below to learn the difference between visiting a dentist who’s in or out-of-network and how these factors will affect the caliber of dentistry that you receive.

What’s the Difference Between HMO & PPO?

Dental insurance is notoriously complicated, which is why so many people dread dealing with their plans. One of the basics that you should know is whether your plan is an HMO (Health Managed Organization) or a PPO (Preferred Provider Organization). This key detail will determine whether you need to go to an in-network or out-of-network dentist for coverage.

HMO coverage is limited to providers that are in-network with the dental insurance company. This means that when you visit an out-of-network dentist with your HMO plan, any treatment that you receive won’t be covered. On the flip side, a PPO plan allows you to choose any in-network or out-of-network provider.

How Do Out-of-Network Dentists Work?

Many highly skilled dentists decide to remain out-of-network with insurance providers, which means that they haven’t negotiated a contract with any insurance company and don’t have any pre-established rates. The best benefit of choosing an out-of-network dentist is that you can pick a skilled professional that meets your specific oral needs. Going out-of-network is a great option for patients who want high-quality dentistry, need complex cosmetic treatments, are looking to receive an advanced procedure (like dental implants), and want the best results, etc. This is because in-network dentists are more restricted on what treatments they can provide based on what your insurance plan will agree to cover. Fortunately, some out-of-network dentists are still happy to file claims on your behalf to help you get reimbursed.

What Does Fee-for-Service Mean?

Just because a dentist is out-of-network doesn’t mean that they won’t work with your insurance. In fact, because so many patients invest in dental insurance, they’re usually happy to help you file claims on your behalf and maximize your benefits. However, this usually comes in the form of a reimbursement, which means that you’ll need to pay for your treatment at the time that you receive it. This is known as a fee-for-service dentist. Afterward, the dental staff will help file a claim with your insurance company so you don’t miss out on taking advantage of your benefits.

Get Better Care & Save Money with Out-of-Network Coverage

As mentioned above, the primary reason why people choose to go to an out-of-network dentist is because of the high-quality care they will receive because they don’t need to deal with the same restrictions that in-network dentists do. When visiting a skilled and experienced dental professional, you may need to pay out-of-pocket for treatment at first, but remember this doesn’t mean that you won’t get reimbursed later! If you have a PPO plan, the dental staff will be more than happy to help you file a claim and get the most out of your investment in insurance.

About the Author

Dr. Stephanie Lacquaniti is passionate about providing outstanding, high-quality dentistry that her patients can trust. She remains committed to advancing her education, sharpening her skills, and keeping up-to-date with the latest techniques and technology in her field by taking courses at SPEAR education and local study clubs throughout Lake County. She uses cutting-edge dental instruments in her office to provide the best results, like her soft tissue laser and all-digital X-ray imaging system. For questions about visiting an out-of-network dentist, don’t hesitate to visit her website or call 352-383-8121.