Insurance coverage is one of the most important resources you can use in daily life to save yourself from a major financial crisis. With insurance, you have guaranteed coverage for care and other emergencies, which can be vital when it comes to your health. However, dental insurance sometimes plays by a few different rules, such as the way that in-network and out-of-network care works.
Dental Insurance: In-Network vs Out-of-Network
Like health insurance, dental insurance is separated into in-network providers and out-of-network providers. In general, an in-network provider is part of your insurance plan and will include care that comes at a discounted or fully covered rate. Out-of-network providers, on the other hand, are not typically covered by your insurance and may require copayments or other fees for services. Cornerstone Dental is very selective as to which dental insurance plans it chooses to be “in-network and participate” with. However, Cornerstone Dental accepts and processes almost all insurances.
Advantages of In-Network Dental Insurance Care
For dental care, there are clear advantages to using in-network providers. When you use an in-network provider, many basic dental services such as teeth cleanings and fillings are covered under your insurance plan. Major dental procedures, such as root canals, typically come at a discounted rate for in-network providers. This means your out of pocket costs will be much lower, and in some cases, you may not have to pay anything.
When dental insurance is used, the dental office must submit a claim to the insurance provider for reimbursement for services. The claim process can be easier for in-network providers. Additionally, finding a dentist can be easier with in-network providers because the dental offices to choose from is usually limited.
Disadvantages of In-Network Dental Insurance Care
There can be disadvantages to using in-network providers. Insurances typically reach out to dental offices to see if they want to become a participating provider and will incentivize dental offices with a steady stream of patients in exchange for deeply discounted fees on services. If a dentist agrees, that dentist will then become an in-network provider and subject to the terms and conditions of the contract signed with the insurance company. Essentially, the dentist is now working for the interests of the insurance company while the interest of the insurance company’s patients are secondary. The dentist works for the insurance company instead of the patient.
With discounted services comes a loss of income. Dental offices start to feel pressure to make up for the loss of income by cutting corners. This translates into the dentist and hygienist rushing the patients in and out of the chair by doing subpar work or offering services that are more profitable but less than optimal for the patient. Lab work may also be outsourced, cheaper dental materials purchased, and more expensive treatment plans proposed to make up for the loss of income.
Advantages of Out-of-Network Dental Insurance Care
There are several advantages to consider when you’re using an out-of-network dental provider. With an out-of-network provider, you can choose from a wider range of dental providers so that you can get the care you need. Out-of-Network dental offices also won’t feel the pressure of discounted prices and are more likely to spend the appropriate amount of time with each patient to provide a higher level of care.
Out-of-network providers are able to put the health of the patient over the interests of the insurance company and aren’t limited to the services or treatment plans they can offer. There is also a better chance of high quality materials with out-of-network dental offices due to the lack of financial pressure. Contrary to what most insurance companies lead us to believe, many insurances pay close to the same amount to out-of-network providers as they do in-network providers, depending on the service.
Disadvantages of Out-of-Network Dental Insurance Care
The biggest disadvantage to an out-of-network provider is the financial aspect. It can be difficult to pay for dental services out of pocket. Many dental offices offer financing options for unexpected and expensive procedures. Cornerstone Dental offers financing through CreditCare and also offers Cornerstone Club, a membership plan for those without insurance.
Other Dental Insurance FAQs
Can You Be Reimbursed for Out-of-Network Care?
There are some circumstances in which you can be reimbursed for getting out-of-network dental care. Depending on your specific insurance plan, you may be able to get out-of-network care and then submit your dental bill to your insurance to be reimbursed for services that are covered by your insurance.
If you go to an out-of-network provider for a dental procedure, some parts of your procedure may be covered by your insurance, which can ultimately lower your out-of-pocket expenses. However, for the most part, your out-of-network care will generally have to come out of your pocket since any reimbursement you get from your insurance will likely not cover the full cost of your procedure.
What Procedures Are Commonly Covered By Dental Insurance?
Regular cleanings, preventative care, dental fillings and crowns, extractions, dentures, and more are usually part of the standard coverage for your insurance. There may be other procedures, such as root canals or wisdom tooth removal, that may also be covered by your insurance plan.
Coverage for Kids
Most dental procedures that are required for children are also covered by insurance. People under the age of 18 generally qualify for kids’ coverage for cleaning and other preventative care. Coverage for kids can be folded into your insurance, your employer insurance, or can be part of a separate policy that is sponsored by the government
Does Dental Insurance Cover Braces or Orthodontic Care?
In general, cosmetic treatments for dentistry are usually not covered by insurance. This means that veneers, implants, braces, and other orthodontic care are likely not covered by your insurance policy. However, most insurance policies can be customized to your exact needs, so if you had the foresight to ask for orthodontic or cosmetic coverage, your insurance may be able to cover partial or total specialized care.
The easiest way to determine whether your insurance will cover braces, orthodontic care, or other cosmetic procedures is to contact your insurance provider and take a look at your specific policy. You also have the option of adding additional coverage to your insurance policy to get discounted rates on specialized care.
Is a Discount Dental Plan the Same As Dental Insurance?
No, a discount dental plan is not the same as insurance. A discount plan is intended to help customers save on dental care costs, specifically costs that aren’t covered by insurance. Usually, your insurance for dental coverage will be paid with a monthly premium, and if you have a discount dental plan, then you are likely going to be paying a second premium for the additional coverage.
Discount dental plans also have the same network limitations as your regular insurance, so if you are going to use a discounted plan, be sure that the network coverage overlaps with your normal dental insurance.
Why Isn't Dental Part of Health Insurance?
Many Americans often wonder why dental coverage isn’t part of your normal health insurance. After all, research shows that the health of your teeth can have a huge impact on the health of the rest of your body. Poor dental health has been linked to a heightened risk of cardiovascular disease, diabetes, and other health problems.
However, dental coverage is not usually part of your health insurance because of the difference between health care and dental care. Even if you have private health insurance, it’s unlikely that your insurance policy will cover any dental care. Most Americans will require separate policies for health and dental.
What Factors Should You Look At When Choosing Dental Insurance?
When you’re choosing any type of insurance, it’s important to choose a policy based on the type of coverage you expect to need. Most insurance will cover emergency services, such as emergency dental surgery, as well as preventative care and other common dental procedures.
However, if you have multiple people that you want to include on your plan or if you expect to need additional services, such as dentures or implants, you should look for an insurance policy that will cover most of your needs. By finding a policy that will provide coverage for most of your dental concerns, you will be able to save on out-of-pocket costs in the future.
Is Private Dental Insurance Better Than Employer Insurance?
For many Americans, the choice between private dental coverage and employer coverage is always something to consider. If your employer offers dental coverage, it’s usually a smart financial decision to opt for employer insurance, since this insurance is usually bundled in with covered procedures and comes with a lower premium. However, you also have the option of adding private dental coverage for any additional procedures you may wish to have, such as cosmetic procedures.
Can Your Dental Insurance Help You Find a Dentist?
Yes, your insurance can help you find a dentist that is within your network. To find an in-network dental provider, all you need to do is contact the member services for your insurance and provide information about your location. Your insurance will then give you a list of options for dentists who are accepting new patients. Your insurance will also be able to tell you whether a dentist is out-of-network.
Going to the dentist is an important part of your ongoing health maintenance, particularly because the health of your teeth can have a significant impact on the health of the rest of your body.
Are You Searching For A Martinsburg Area Dentist For You Or Your Family?
If you’re searching for an experienced dentist please feel free to contact us online or call our Martinsburg, West Virginia dental office directly at 304.267.6059 to schedule your appointment. We provide a wide range of general dentistry care as well as more involved dentistry services for patients throughout the Martinsburg area and look forward to you joining the Cornerstone Dental family.
