Jaycee Brown

Jaycee Brown

Director of Communications

Going Out-of-Network

Some people with PPO plans go to in-network dentists in order to get more coverage. Some of these dentists may change to an out-of-network status by dropping the PPO plan for reasons, such as “the lower negotiated fees required to participate in dental networks” (“Why is my dentist Out of Network?”). Dentists should take the time to discuss the differences between being in-network and out-of-network with their patients as an act of good customer service because not everyone thoroughly understands their insurance policy (“Does ‘Do You Take My Insurance?’ Equal ‘Are You In-Network?’” 2015). Although patients could change to another dentist that is in-network, they could continue going to the same dentist (Dwilson 2018). However, they would receive less coverage and more out-of-pocket payments (Dwilson 2018). Furthermore, they may run out of their yearly maximum more quickly (Dwilson 2018). Alternatively, they could enroll into another dental insurance policy that the dentist is in-network, but “they might face a waiting period before pre-existing conditions are covered, depending on how the new plan works” (Dwilson 2018). Despite the increased costs of going out-of-network, patients could still benefit from going to out-of-network dentists.
Out-of-network dentists can focus on providing high quality service in their practice. Their clinics may contain great dentists and employees that patients appreciate as well as provide any other “amenities” (“Does ‘Do You Take My Insurance?’ Equal ‘Are You In-Network?’” 2015; “Why is my dentist Out of Network?”). Dentists may go out-of-network in order to be unhindered by not only the insurance company’s decreased fees, but also the company’s influence on their treatment plans (“Does ‘Do You Take My Insurance?’ Equal ‘Are You In-Network?’” 2015). Without such restrictions, they do not have to be concerned with providing inferior services solely because they are covered by insurance companies (“In-Network vs Out-of-Network”). For instance, instead of providing silver, amalgam crowns that some insurance companies usually cover, out-of-network dentists could provide “the white, porcelain fused to metal crowns,” which may look more appealing to patients (“In-Network vs Out-of-Network”). Dentists that dropped from a PPO network should discuss with patients in-house that they wanted to prioritize patient care and high-quality service without worrying about insurance coverage (Rossi 2001). While they technically do not have to process out-of-network claims, they should assist their patients with these claims (Rossi 2001). Also, sometimes, patients may still have good out-of-network coverage, which may give them more incentive to go to an out-of-network dentist (Rossi 2001).
While some patients with PPO dental insurance may bristle at less coverage from out-of-network dentists, they could reconsider going to them. Out-of-network dentists do not have to worry about insurance influencing the way they provide treatment. Instead of being concerned about whether there is coverage for a certain procedure, they could focus more on providing excellent procedures that betters their patients’ oral health. Consequently, patients could then be more willing to go out-of-network.

Works Cited
“Does ‘Do You Take My Insurance?’ Equal ‘Are You In-Network?’” Plainfield Dental, August
26, 2015. https://www.plainfielddental.com/does-do-you-take-my-insurance-equal-are-you-in-network/.
Dwilson, Stephanie Dube. “What to Do When a Popular In-Network Dentist Moves Out of
Network.” Benefits Bridge, July 23, 2018. https://benefitsbridge.unitedconcordia.com/what-to-do-when-a-popular-in-network-dentist-moves-out-of-network/.
“In-Network vs Out-of-Network.” dental TLC. Accessed December 13, 2018.
Rossi, Bill. “Cutting out the PPOs.” March 1, 2001.
“Why is my dentist Out of Network?” EasyDentalQuotes. Accessed December 13, 2018.


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