When it comes to insurance, oftentimes you will hear the terms “in-network” or “out-of-network.” Dentists who are “in-network” have agreed to a personal contract with a benefit plan. These contracts have restrictions and requirements and usually dictate adherence to a reduced fee schedule. Therefore, patients who chose an “in-network” dentist typically will pay less of their own money toward treatment than those who choose an “out-of-network” dentist. In addition, an “in-network” dentist usually is paid directly from the insurer and payment is sent to the office.
An “out-of-network” dentist has not signed a contract with the insurer of a particular plan. However, patients may still choose that dentist and have some of their fees covered, but they may pay more out of pocket. Also, plan payment checks are usually sent to the patient, not the dentist. The plan pays the patient, and then the patient pays the dentist. Or the patient pays the dentist and is later reimbursed by the plan.
A dentist who decides to become “in-network” may choose to do so because a large population of patients are on the plan, because s/he likes the security of receiving payment checks directly, or because the fee schedule seems fair. A dentist may decide to stay “out-of-network” because a smaller population of patients uses a particular plan. The dentists may be content with patients receiving payment checks. Or s/he may not be comfortable with the fee schedule. Be sure you have a very clear understanding of what specifically is dictated in the contract before becoming an “in-network” dentist.