Knowing Your Plan: In-Network vs. Out-of-Network Coverage

October 12, 2023

Filed under: Uncategorized — dr_dawoud @ 3:42 pm
a tooth covered by a large umbrella

When it comes to undergoing dental treatment without breaking the bank, having an insurance plan can be a real game-changer. That said, since it’s different from medical insurance, it might be challenging to make sense of your policy. For instance, you may have benefits depending on whether you choose an in-network or out-of-network provider. Read on to learn the differences between these two options so you can make the most of your dental coverage before the end of the year!

How Do In/Out-of-Network Dentists Work?

If you have medical insurance, then going to an out-of-network provider usually means you won’t get any coverage for your treatments. This isn’t always the case with dental plans. With dentists who aren’t part of your network, you might still have benefits that can lower your out-of-pocket expenses. Those who are in-network may already have established rates with your insurance company, which usually means you can expect much more affordable services while helping you avoid breaking the bank.

What Does PPO and HMO Mean?

You might have one of two kinds of dental insurance plans:

  • Health Maintenance Organization (HMO): This kind of plan provides dental coverage for monthly or annual fees. This will limit the providers you can visit if you wish to make use of your benefits, but you can also enjoy advantages such as lower premiums.  
  • Preferred Provider Organization (PPO): This type of coverage can allow you to undergo dental treatment at a lower rate than if you paid completely out of pocket. The good news is that you can choose any dental professional you prefer. For in-network dentists, you can undergo care at pre-established rates, whereas out-of-network ones will require you to pay the total cost on your own. However, you can still file a claim afterward and be reimbursed.

Remember that any of your unused benefits will go to waste at the start of January 2024, meaning you’ll be responsible for your yearly deductible again. With the end of the year coming up, now is the best time to schedule your next visit and take full advantage of your insurance plan!

About the Practice

At D&G Dental of West Orange, we want to ensure that you can get the dental care you need without worrying about breaking the bank. That’s why we’re proud to be in-network with most PPO dental plans, and we’re also happy to accept certain out-of-network insurances. If you have any questions about in-network and out-of-network coverage, visit our website or reach out to us at 973-731-2200.

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