What does out of network mean in dentistry?
It is not the same as medicine, which is what most think about when hearing that term. The exact difference will be completely dependent on the plan your employer purchased. Sometimes the plan has set limits in the coverage levels or the maximum. The main difference is that when you are going in-network the insurance company set the fee. Therefore, you may be paying less for your co-payment if you go in-network. For example, a filling in-network may be $100 and out-of-network be $120, if your co-payment is 20% you are paying $20 in-network and $24 out-of-network. The nice thing about this is that your insurance is paying the lion’s share of the increase. This allows you to typically get better quality while only having to pay a little more for it.
Disadvantages of the in-network office
Dental offices have a lot of decisions to make as far as the quality they decide to provide. Remember, dentistry is one of the few things left that is custom made by real people. The dentistry is all done by the dentist and crowns and dentures are made by a lab technician. The lab technicians’ fees vary significantly based on their quality. An out of network office will be financially able to provide a higher level of quality. The more extensive dentistry you require the more you should look for quality that will last.
Another issue you will find at in-network offices, and especially corporate offices, is the up charges. That could be trying to talk you into dentistry that may not be necessary or upgrading to a service that your plan doesn’t cover, allowing them to charge whatever they want. Often they lure patients in with ridiculous cheap cleanings and/or first patient exams and then pull a bait and switch and try to up charge you for everything they can. Furthermore, unless you have one of the worst plans that office takes, you are subsidizing the care of everyone else and getting a level of care that is below what you deserve.
Finally, dentistry is not immune from the technological advances of society and those have significant costs. We know of many offices that look, feel, and practice the same way they did when the dentist graduated dental school and are using the same equipment. Is that what you want for your dental care? An in-network office will rarely have the funds to stay update or be able to have nice equipment or maintain it properly.
How are medical insurance and dental insurance different?
To make it brief, dental plans are not insurance and medical plans are insurance. Dental plans are really pre-payment plans that start paying right away and then max at $1,000 or $1,500. Medical insurance kicks in AFTER you reach a minimum deductible and then cover the expenses after that number, that is a true insurance.
I don’t have any dental insurance
In our office, everyone pays the same fee. At an in-network dentist, everyone pays a different fee based on the deal the insurance company made with that individual office. If you do not have insurance, you are without question being charged more than anyone else going to that office. In many cases it will be 15-40% more, so a lot. We have a hard time justifying providing a service for x and 40% more to the next person. Is that fair to the person paying that much more? Is the office losing money on the one and making it up on the other? I don’t like the idea of the individual without dental insurance, subsidizing the care of those with insurance. It is inherently unfair in my mind. If you have no dental insurance, don’t go to a dental office that is in-network with a lot of plans.
I have a DMO or HMO, do you accept that?
Unfortunately we do not accept any of those plans. While nothing prevents you from choosing us as your dental provider, your plan wouldn’t pay us anything. Therefore, you would be responsible for 100% of your fee. Finding a dentist you like that takes these plans can be difficult. I recommend trying the dental schools.
I have Medicaid or All Kids, do you accept that?
We do not accept those plans. It will be difficult to find an office that accepts these plans that you like. You can go to the All Kids website to find a provider. I recommend trying the dental schools.
UIC – Chicago
Midwestern – Downers Grove
Do I qualify for free dental care?
If your household income is low enough, there are options for free basic dental care in the area.
DuPage County Health Department will extract teeth.
DuPage also has a clinic where doctors volunteer to work with those that qualify.
