“In-network” and “out-of-network” sound like a yes-or-no question, but the answer affects three separate things: which dentists you can see, how much the plan pays, and how much is left for you. It’s worth sorting out before you book an appointment, and before you pick a plan during open enrollment.
What the terms mean
An in-network dentist has a contract with your insurance company. They’ve agreed to charge the plan’s allowed fee for each procedure, and the plan pays its share directly. You usually owe a copay or whatever is left of your deductible.
An out-of-network dentist has no contract with your plan. Many PPO plans still pay part of the bill, but they base that payment on their own estimate of what the procedure should cost. You owe the difference between that estimate and the dentist’s actual fee.
How it affects what you pay
In network, your share is usually predictable. Out of network, it depends on the gap between the plan’s allowed amount and the dentist’s fee, so it takes a quick estimate to know.
Networks also limit who you can see. An in-network plan steers you toward contracted providers, while out-of-network coverage leaves your choice open. Some plans are much more generous in network and pay little or nothing outside it for certain work.
If you’re not sure how your own plan handles this, our post on how dental insurance works covers the basics.
Why out of network can work in your favor
Many people assume an out-of-network dentist always costs more. With a fee-for-service practice, that often isn’t true. Because a fee-for-service office bills its own fee instead of a discounted contract rate, some PPO plans end up reimbursing more for the same procedure than they would to an in-network office.
Fee-for-service practices also aren’t steering you toward the cheaper treatment a plan prefers. You and your dentist decide what’s best for your long-term oral health. We explain this in more detail in why fee-for-service practices offer better care for patients.
Dr. Smile is a fee-for-service practice. We accept most PPO plans and check your benefits before treatment, so you know your network status and your likely out-of-pocket cost before you agree to anything.
Deciding what’s right for you
If you mainly get routine preventive care and want costs to be predictable, an in-network plan and provider keeps things simple. If you care more about choosing your dentist and your treatment, an out-of-network fee-for-service practice gives you that freedom, and it may cost less than you’d expect once the plan’s reimbursement is counted. If you have bigger work planned, ask your dentist to run the numbers both ways first.
Whichever way you go, confirm your network status and expected cost before treatment starts. You can contact us to find out how your plan works with Dr. Smile, or find the office nearest you in Newport Beach, San Pedro, Torrance, or Lomita on our location page. If you’re still choosing a plan, start with how to choose the best dental insurance plan.