Choosing a dentist you trust is an important decision, but questions about dental insurance can sometimes make the process feel confusing. One of the most common concerns patients have is whether they can still receive care if their dentist is out of network with their dental insurance plan.
The good news is that, in many cases, the answer is yes.
At Healthy Smiles Dental, we routinely care for many patients whose dental insurance considers us out of network. We bill all dental insurance plans except Medicaid on your behalf, making it as easy as possible for you to receive the dental care you need while helping you maximize your available benefits.
What Is a PPO Dental Insurance Plan?
Many dental insurance plans are PPO plans, which stands for Preferred Provider Organization. While the name may sound technical, the concept is fairly simple.
A PPO plan gives you the flexibility to choose your own dentist. Insurance companies have networks of dentists who have agreed to accept the insurance company’s approved fees for covered dental services. These dentists are considered in network.
Most PPO plans also allow you to visit dentists who are out of network. Depending on your specific plan, your insurance may still help pay for covered dental services when you choose an out-of-network provider. That flexibility is one of the reasons PPO plans are so popular.
What Does “Out of Network” Mean?
Being out of network simply means Healthy Smiles Dental does not participate in a contract with some insurance companies. It does not mean you cannot receive care at our office, and many PPO dental insurance plans still provide benefits for covered services.
Many patients are pleasantly surprised to learn they can continue using their dental insurance benefits even when they choose an out-of-network dentist.
We Bill All Dental Insurance Plans Except Medicaid
One of the biggest misconceptions about out-of-network dental care is that patients must submit all of their insurance paperwork themselves.
At Healthy Smiles Dental, we bill all dental insurance plans except Medicaid on behalf of our patients. Our team routinely files insurance claims for patients with out-of-network dental benefits, making the insurance process as convenient as possible and allowing you to focus on your dental health rather than paperwork.
Will My Insurance Still Help Pay?
Another common misconception is that dental insurance will not pay anything if you visit an out-of-network dentist. Many PPO dental insurance plans continue to provide benefits for covered services received from out-of-network providers.
Every dental insurance plan is different, so the amount your insurance pays depends on the details of your individual policy. Our team is always happy to answer your questions and help you better understand your available benefits.
How We Estimate Your Benefits
Before treatment, our team contacts your insurance company whenever possible to gather information about your coverage and provide the most accurate estimate we can.
Because Healthy Smiles Dental does not participate in every insurance network, we do not always have access to the fee schedules insurance companies use to calculate payments. We use the information available from your insurance company to prepare the best estimate possible before treatment.
Once your insurance company processes your claim, they issue an Explanation of Benefits (EOB) that outlines the amount they have paid and any remaining patient responsibility.
Why Patients Choose Healthy Smiles Dental
Patients choose Healthy Smiles Dental for many reasons, including personalized care, a comfortable environment, and a team that takes the time to answer questions and explain treatment options.
Whether your dental insurance considers us in network or out of network, our goal is the same: to provide exceptional dental care while making the insurance process as simple and straightforward as possible.
We Are Here to Help
Understanding your dental insurance benefits does not have to be complicated. If you have questions about your dental insurance, you do not have to figure them out on your own.
Our knowledgeable team is happy to answer your questions, explain the information available about your coverage, file your insurance claims on your behalf, and help you make the most of your dental benefits. Whether Healthy Smiles Dental is in network or out of network with your insurance plan, we are committed to making the process as easy as possible so you can focus on maintaining a healthy smile.
If you have questions about your dental insurance benefits or would like to schedule an appointment, contact Healthy Smiles Dental today. We look forward to helping you achieve and maintain excellent oral health.
Frequently Asked Questions
Can I still use my dental insurance if Healthy Smiles Dental is out of network?
In many cases, yes. Many PPO dental insurance plans allow patients to receive care from out-of-network dentists while still providing benefits for covered services. Our team is happy to help you understand the information available about your specific plan.
Does Healthy Smiles Dental file my insurance claims?
Yes. We bill all dental insurance plans except Medicaid on behalf of our patients, helping make the insurance process as simple and convenient as possible.
Will I know what my insurance will pay before treatment?
Our team contacts your insurance company whenever possible to gather information about your benefits and provide the most accurate estimate available. Because insurance companies determine benefits after processing a claim, final benefit amounts may differ from the initial estimate.
What is an Explanation of Benefits (EOB)?
An Explanation of Benefits, or EOB, is a statement from your insurance company that explains how your claim was processed, what benefits were paid, and what portion, if any, remains your responsibility.