What's the difference between an In-Network Provider and an Out-of-Network Provider

The ins and outs of dental insurance can be extremely confusing and frustrating.  We read phrases like, "the usual and customary," "fee schedule," "PPO contracted," "HMO contracted," "in-network provider," "out-of-network provider," among others, with no real clear difference or comparison of the pros and cons of each.  Most dental benefits are just that, a benefit.  Much different than medical insurance, dental typically only pays a certain amount in a calendar year leaving much to be desired in the realm of dental health.  So let's get down to the nitty gritty of the situation and shed some light on the underworkings of dental benefits and dental providers. 

When a dental office decides to contract with certain dental insurances they are agreeing to a set fee schedule that will be paid to the provider depending on the service that is being billed to the insurance.  So, let's say in a particular dental office that they charge $90 for a limited exam but the dental insurance agrees to pay them $45.  If that dentist is contracted with this dental insurance paying 100% of the patients portion, there is really no time to give a proper exam, so instead they are going through patients as if they're on a conveyor belt.  Proper care goes out the door because if they don't take enough patients in a day to cover loss then they will not be able to keep their doors open.  To subset their loss on patients with dental insurance they will also charge their cash paying patients more!  Bad experiences at the dentist seem to be a common theme among many building anxiety and fear that eventually causes people to avoid the dentist until they're in so much pain they have no other choice.

Here at First Impression Dental, Dr. Lent has decided to be a non-contracted or Out-of-Network Provider.  Meaning, we still accept all PPO dental benefits but without being contracted to any particular dental insurance and their fee schedule.  This allows us to provide our patients with detailed and personally tailored care that exceeds the usual and customary.