Insurance can be confusing and difficult to navigate. It may be that insurance companies like to keep it that way because many people give up even trying to understand insurance when it gets too complicated.
So, when people hear about in-network vs out-of-network options, there can be many misconceptions. Many of these misconceptions are framed by the insurance companies to keep people within their network. The larger the networks they build, the more money they make.
Basically, insurance companies aggressively approach doctors and say, “If you will join our network, we will provide you with plenty of patients.” The insurance company then requires that the doctor write off between 30% to 55% of their fee. This comes with real consequences as the doctor has to make significant changes to how they treat people in order to afford to stay open. These changes rarely benefit the patient.
The out-of-network dentist is able to spend an appropriate amount of time with each patient, which is on the average, three times longer than with an in-network dentist. An in-network dentist has to see 2 to 3 times more patients a day in order to make up for all the fee write-offs for the insurance company. This means that you, as the patient, get short-changed. It takes time to really listen to patients. It takes time to properly diagnose problems within the mouth. It takes time to help people relax and do quality work. It takes time to numb patients comfortably. Haste makes waste. Many mistakes can be avoided by slowing down and allowing the proper amount of time to do the job right.
The out-of-network dentist is able to put your health first and foremost. The out-of-network dentist is working for you and can give you an unbiased opinion on your dental condition and needs. An in-network dentist has a contract with the insurance company and is often limited on certain procedures they can offer or may feel pressure to steer you towards certain treatments due to payment contracts. When it comes to something as important as your health, it pays to see someone who puts your personal needs and desires above an insurance claims reviewer.
The out-of-network dentist does not feel pressured to cut their overhead by using cheap materials. There are many “knock-off” products available online that just don’t stand the test of time and don’t have a reputable company name to stand behind them when they fail.
Staying out-of-network means you get to choose your own dentist freely and not pick someone just because they are on an insurance list. Chances are that you will bond better with practitioners of certain personality types. Many in-network offices have lots of practitioners who cycle in and out of the office. An out-of-network office can usually afford to hire a top quality team that stays consistent over many years so that you know who you will see when you return.
The out-of-network dentist typically participates in far more quality continuing education year after year. Technology is rapidly changing and quality education programs are expensive and time consuming. Don’t you want to see a dentist who stays up to date to provide you with the best care possible?
Sometimes, insurance companies pay pretty close to the same amount to an out-of-network dentist as they do to an in-network dentist. You can not automatically assume it will be significantly more expensive to go out-of-network, but you do want to investigate this. Sometimes it is, sometimes it isn’t. It all depends on how much your employer is paying in annual premiums to the insurance company. However, when it comes to something as important as your teeth, it is worth the extra expense for all the reasons just mentioned. The choice is yours.