When it comes to dental care, one of the most common concerns is whether to stick with in-network providers to avoid higher out-of-pocket costs. However, it’s essential to understand that you shouldn’t be overly concerned about being out-of-network if it means receiving the right care from a dentist you trust. Many insurance plans offer excellent reimbursement for out-of-network services, allowing you to prioritize quality care over network restrictions.
If you have insurance, fingers crossed you are using it to the max, getting two cleanings and exams per year, and taking care of necessary treatments as quickly as possible. But many people don’t really understand their insurance. Dental insurance is a lot more mysterious than medical insurance, and there are some ins and outs you need to be aware of.
At our practice, we are proud to partner with Delta Dental, Pacific Source, and BCBS of Oregon as in-network providers. However, we can also bill any insurance provider, with the exception of Oregon Health Plan (OHP), as an out-of-network provider. While depending on the service, this may mean higher out-of-pocket costs, the investment in your dental health is often worth it.
The Importance of Preparation – Know Before You Go
The old adage, “better safe than sorry,” rings true regarding insurance, and we firmly believe in helping our patients be informed consumers. For new patients, we recommend you request a pre-determination estimation of your benefits before coming in for your first appointment. This process can take 2-3 weeks, so planning ahead is key. Additionally, verifying your insurance coverage a couple of weeks before your dental appointment ensures you are fully aware of what’s covered.
We strive for transparency in all our financial estimates. Each visit receives a detailed breakdown, including all relevant CPT codes, so you can contact your insurance and understand coverage options. In emergencies, such as a broken tooth, we provide estimates on the spot to ensure you are aware of your out-of-pocket expenses and can consent to treatment.
What’s an Annual Maximum?
It’s important to note that many insurance plans have an annual maximum regardless of whether you are in-network or out-of-network. This maximum typically ranges from $1,000 to $2,500 per calendar year. Once this limit is reached, any additional costs will be out-of-pocket, something many patients are unaware of.
Timing Matters
Knowing when your insurance plan renews is crucial; some operate on a fiscal year, while others follow a calendar format. Benefits don’t carry over from year to year, so it is important to use them before you lose them. For Oregon teachers, plans typically reset in October, while others reset on January 1. Be sure to plan dental cleanings, exams, and necessary procedures accordingly.
Additionally, weigh the pros and cons of postponing treatments like crowns. We get the desire to wait until your insurance kicks in, but you must ask yourself if your tooth can handle the wait. Will delaying treatment result in worse conditions or increased pain later? The future is unpredictable, and acting sooner rather than later often pays off.
Choosing Quality Care Over In-Network Status
A common misconception is that being in-network is the only way to go. In reality, some insurance companies offer very few in-network providers in local areas – especially in small cities like Bend. We encourage patients to explore their options and consider care quality when selecting a dentist. Choosing a dentist solely based on insurance coverage isn’t always the best choice. Most dentists in the area have stopped participating with insurance plans that offer the worst coverage. If you find one that no one else partners with, inquire about why that is the case.
As one of our satisfied patients, Spencer, noted, “I choose to go here outside of my dental insurance network because of the amazing experience I have each time.” His sentiment echoes the feelings of many who prioritize comfort and trust over insurance affiliations.
Alternative Solutions to Dental Insurance
For those without insurance, we offer an in-office savings plan through Quality Dental Plan. This comprehensive plan covers all preventive care, including cleanings, x-rays, and exams at 100%. It also provides exclusive benefits on restorative and even cosmetic treatments. It’s a great and affordable option for families looking to manage costs while receiving quality dental care. You can learn more about it here.
Ultimately, your oral health is too important to leave to the constraints of insurance networks. Evaluate the quality of care available, consider your options, and don’t hesitate to choose a dentist you feel comfortable with. Whether you utilize your insurance, pay out-of-pocket, or explore our in-office savings plan, what truly matters is that you can achieve the smile you’ve always wanted without unnecessary stress.
Want to go deeper? Here's how going out-of-network can actually save your teeth and wallet, and why not all dentists are created equal. If you have questions about your coverage or our services, please ask us! We are here to help you navigate the mysterious world of dental insurance.