Tips for Getting Dental Treatment Out of Network

For general dentistry, carrying even a baseline dental insurance plan is a good idea to help cover routine visits and any minor treatments. However, dental insurance plans can be limited in what kind of specialty care they will cover, including implants, crowns, bridges, dentures, jaw disorders, and more. When selecting a prosthodontist for work like dental implants, you shouldn’t have to be limited further by whether or not your preferred doctor is in or out of network.  

But dental insurance can often be complicated and just plain confusing. For instance, some insurance plans allow you to reimburse your cost for specialty dental treatments even if you see a dentist that is out-of-network while others will require you to pay entirely out of pocket. If you decide to go out-of-network entirely, there are a few potential benefits, especially from a specialist such as a prosthodontist.

HMO vs PPO Insurance Plans

It’s your responsibility as a patient to know whether a particular provider is in or out of your network. You'll find this information from your dental insurance provider directly as they typically provide either a list or search results for dentists in your area on the insurer’s website.  

If you have an HMO insurance plan you can only receive benefits for services performed by in-network dentists, nothing will be covered if it's performed by out-of-network providers.  

With a PPO plan, you pay for out-of-network care out of pocket, then make claims and receive reimbursement for any treatments covered by your plan.

Both plans offer flexibility for out-of-network care, however, the major differences are more often related to patient costs.  

Coverage Limitations

Some treatments, however, are simply not covered by insurance, regardless of your plan. It’s important to be aware that treatments such as dental implants and other types of prosthodontist care are often excluded whether or not you’re in network. The good news is this means that you now have the benefit of flexibility and freedom to select the prosthodontist that’s right for you.  

Benefits to No Dental Insurance

When a dentist is part of an insurance network, they are forced to accept the rates set by the insurance company. Those rates are usually higher than what they'd charge you directly. If you choose to see a specialist who is not an in-network provider, oftentimes payment plans are available. And because your prosthodontist will not be limited to treating only the symptoms or issues that are fully insured, your experience and care as a patient is elevated – better care, better treatments, and better outcomes.

Understanding the Costs

When selecting a fee-for-service or out-of-network prosthodontist, and while discussing with them what kind of specialty dental care you are best suited for, you can request a clear estimate of costs for all treatments before committing. No surprises, no hidden fees.  

Making a Claim

Some patients with PPO insurance plans will still need to make insurance claims even after seeing an out-of-network provider. Let your dentist know that you're planning to make a claim so they can provide you with the right information, or help you with filing if needed.  

Choosing a Prosthodontist

When searching for a dental specialist in Columbus for dental implants, overdentures, All-on-X, or more, don't let dental insurance stop you from receiving the care you need. Here at The Oral Implant and Reconstructive Dentistry, we are a fee-for-service specialty practice offering payment plans and military discounts. With decades of clinical and surgical experience in implants, reconstruction, and general dentistry, we’ve seen it all and solved it all, and we’re eager to offer life-changing care to restore your smile.  

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