Why Dentists Go In And Out Of Network
Posted Aug 02, 2024When you purchase dental insurance or your employer provides it, it’s usually a plan that is referred to as a “preferred provider organization” or PPO plan. A PPO plan finds dentists that will agree to charge an agreed upon amount for any given procedure. They cannot charge more…the fee has been set already. This creates a network of dentists that have agreed to charge a lower, agreed upon fee. Those dentists are “in-network” with the insurance plan.
Why would a dental office not participate in these networks? There are a few reasons. Some offices are in areas with little competition so there is no need to sign up with these plans to attract patients. Or they have built a large following and now have no need to agree to a fee schedule. Their patients are fine paying what the dentist charges as they don’t want to go anywhere else. Some offices have built a niche of performing cosmetic dentistry. These offices focus on people who want a lot of cosmetic work done and insurance rarely pays for those procedures anyway. There is no benefit to sign up with these plans.
But there is a more common reason why offices may not be in network. What the general public does not know is that these plans can very widely in what they pay the dentist and staff. Some plans pay quite well- at or near what a dentist would usually charge. Some plans are not so good. And some are downright terrible in what they reimburse the dental office.
All businesses need to operate on a profit. If the insurance company pays the dentist or hygienist just above what it costs them to provide the service, why would they bother? Or why would they GO IN DEBT to provide the service? It is true- several plans pay so little that the provider would be paying for the opportunity to do them.
Everyone thinks dentistry is expensive. I doubt dentists will get any sympathy about not being reimbursed enough. There is still a cultural myth of dentists and physicians being millionaires and being on the golf course when they aren’t at the office. The money just flows in. You can believe what you want but no dentist or physician I know owns those multi-million dollar buildings downtown. I know who does, though.
At Plainfield Dental, we are in-network with many insurance companies. We understand cost is a major factor in getting treatment. A business should be efficient and there should be pressure to keep costs down for patients. Competition is good for the patient. We always strive to be competitive and if we can give high quality care at the fees your insurance company allows, we are in network with them. But some insurance companies reimburse so little that we would have to compromise on the care we provide. And that won’t happen. There has to be a balance.
Also, one last note. We have noticed that when we accept insurance but aren’t in-network (you can usually use your benefits at any dental office regardless if they are in-network or not), we have noticed that the out of pocket expenses for the patient may not change or the change is minimal. It’s up to you to determine if that small change is worth it.