Short Description
A dentist who does not have a contract with an insurance company, resulting in higher costs and potential balance billing for patients.
Long Description
An out-of-network dentist is a provider who does not participate in a patient’s dental insurance network. This means they have not agreed to discounted rates with the insurance company, and patients may be required to pay higher fees for services.
Key differences for out-of-network care:
Insurance may cover a lower percentage of treatment costs
The patient may be responsible for the difference (balance billing)
Claims may need to be submitted by the patient instead of the dentist
Patients should check whether their provider is in-network to avoid unexpected costs. Some PPO plans provide partial reimbursement for out-of-network care, while DHMO plans typically offer no coverage for out-of-network providers.