Why Choosing In-Network Dentists Saves You Time and Money

You have dental insurance? Terrific, and thank you for your business if you are a Delta Dental of Arkansas member.

But having insurance is only part of the story. To get the maximum dental benefits and minimize your out-of-pocket expenses, you’ll want to obtain your dental care from “network” or “in-network” dentists.

Our blog explains why it matters and how using a network dentist can save you time and money.

Definition: In-Network vs. Out-of-Network Dentists

Network dentists, also called “in-network dentists,” have contracted with dental insurance carriers to care for their members for agreed-upon prices. Obtaining dental and vision care from a network provider will give you the full insurance benefits and the most value for your money.

The agreed-upon prices may be lower than the dentist’s regular charges, but according to the contract with the insurance company, the dentist is not allowed to bill you for the difference between the agreed-upon price and his/her regular charges, a practice referred to as “balance billing.”.  

In contrast, out-of-network dentists receive lower reimbursement rates from the insurance company and may bill you for the rest. You end up paying more.

A Comparison of In-Network vs. Out-Of-Network Dental Benefits: Preventive Care

Let’s crunch some numbers.

Here is a hypothetical, simplified example contrasting your out-of-pocket expenses for preventive dental treatments obtained from in- vs. out-of-network dentists:

Dentist A is a participating provider in your dental insurance company’s network. She’s considered a network or in-network dentist. After she takes care of your semi-annual oral exam, teeth cleaning and x-rays, her office submits total charges of $196 to your insurance company.

Your Dental Benefits from a Network Dentist

Because Dentist A is a network dentist, she has agreed to care for the insured members at contract prices, which are lower than her regular charges. In this case, the agreed-upon price is $125, so the insurance company pays her a total of $125.

What about the balance of $71 ($196 - $125 = $71)? That’s a discount you receive as a covered member. You are not responsible for paying that balance.

Come again? Why are you not responsible for the balance?

There are 2 reasons why you don’t pay anything for this particular dentist visit:

1. The dental care you received comprised an oral exam, teeth cleaning and x-rays. Those treatments are considered “preventive care,” which almost all dental insurance companies cover in full as long as their members obtain the care from a network dentist.
2. The network dentist has consented to accept agreed-upon prices for your dental treatment. She has contractually agreed to accept the insurance payment and not “balance bill” its members.

Check out this “At-A-Glance” Summary:

Here is one other benefit of obtaining care from a network dentist:
Their office will submit the claim, not you. So you save time.

Your Dental Benefits from an Out-of-Network Dentist

Let’s compare that to what you’d pay to an out-of-network dentist, Dentist B. Let’s assume he charges the same amount, $196, for the same preventive care treatments.

The first difference is that you may be asked to pay the entire amount upfront. So you need to get your checkbook or credit card out and pay the whole $196.

Then you, not the dental office, are responsible for submitting the claim to your dental insurance company for processing.

So after you’ve had your basic oral exam, teeth cleaning and x-rays, you spend quite a bit of time

• searching online for the proper forms
• downloading, completing and mailing or submitting the forms online, and
• waiting to be reimbursed for some of the costs.

NOTE: This process can be a bit easier and faster if you are a longtime patient or the dentist has an established relationship with the insurance company. In that case, the dental office might calculate our expected out-of-pocket expense and charge you only for that amount at the time of your visit. It might also file the claim for you.

You’ll Pay Higher Out-of-Pocket Costs for your Dental Care

In this example, your insurance company will process the claim for your dental treatment from an out-of-network dentist as follows:

It will pay the contract price for network dentists less a specified percentage. Let’s assume the percentage is 10%. That means the insurance company would cover the claim at

$125 – 10% ($12.50) = $112.50.

It will send the check for $112.50 either to you or the dentist, depending on your plan.

You are responsible for the balance of $196 - $112.50 = $83.50.

You may have already paid that amount (or more) during your visit. Suppose your and the insurance company’s payment have resulted in an overpayment to the dentist. If yes, you’ll want to request a partial reimbursement from the dental office, requiring yet more of your time.

Here is Another “At-A-Glance” Summary:

The Bottom Line:

Your out-of-pocket expenses for obtaining preventive dental care from an in-network dentist are zero.

Your out-of-pocket expenses for obtaining preventive dental care from an out-of-network dentist are $83.50.

A Comparison of In-Network vs. Out-Of-Network Dental Benefits: Crown

Let’s look at another example: You need a crown.

Your insurance carrier classifies a crown as a “major service,” which is covered at 50% of the network rate if services are obtained from an in-network dentist. Let’s assume you also have to pay an annual deductible of $50. 

Both the in-network dentist and the out-of-network dentist charge $1,128 for a crown. The agreed-upon price for in-network dentists is $845.

Let’s compare your dental benefits and out-of-pocket expenses using a network dentist, Dentist A, vs. an out-of-network dentist, Dentist B.

Dentist A, In-Network

Dentist B, Out-of-Network

The Bottom Line:

Your out-of-pocket expenses for obtaining a crown from an in-network dentist are $447.40.

Your out-of-pocket expenses for obtaining a crown from an out-of-network dentist are $772.75.

In-Network or Out-of-Network—The Choice is Yours

These cost comparisons show how obtaining dental care from in-network dentists saves you time and money.

To be clear, you don’t have to go to a network dentist. You are free to choose your dental provider. Just know that your choice affects your dental benefits and out-of-pocket expenses.

If you’re not quite sure about your dentist’s participation or if you’re looking for a new dentist, check our Find-A-Doctor tool. As a Delta Dental of Arkansas member, you’ll discover that more than 95% of the state’s dentists are in the Delta Dental network.  

All In for Dental Insurance? Check out Delta Dental Options

If these examples have prompted you to consider purchasing dental insurance for yourself, your family or your employees, check out our different coverage options. Delta Dental of Arkansas offers a variety of competitively price dental and vision plans for individuals/families and small, mid-size and large businesses.