Does “Do you take my insurance?” equal “Are you in-network?”

Do you think the above means the same thing? Most patients do. But it really does not. When you call a dental office and ask, “Do you take my insurance?” without asking any additional questions, almost 100% of the time they will say “Yes”. But are you and that office agreeing on what that means?

Let’s define some things. “Taking insurance” just means that the dental office will file a claim to your insurance on your behalf. They are free to charge what they want and what is not covered by your insurance, you pay. They are not tied to any fees dictated by the insurance company.

What does “in-network” mean? It means that your insurance company has already negotiated the fees on your behalf and that is all the dental office can charge. Usually, this means it’s more affordable for you. I say usually because there are some shenanigans that offices pull in order to charge you more than necessary but that’s for another article. But generally, you pay less.

So, was the office you went to lying when they said they took your insurance but after a few visits you realize that they were not in-network? No. But it might be a good public relations move for these offices to explain the differences on the front end. In their defense, you’re ultimately responsible for what plan you purchased. Dental offices are not obligated to walk you through your insurance plan. But we usually do it as a courtesy.  Dental plans are incredibly confusing (even for us and we deal with them daily).

Here’s another thing I hear: “I wasn’t allowed to go to my last dentist because he is out of network”. Not true! If you liked the guy and the staff, you can still go there! The insurance company police will not track you down and throw you in jail! Unless you made a radical change (like going from a PPO to and HMO), you can still see the doctor you like and use your dental benefits. Yes, you may pay a few bucks more but it may be worth it to you!

Why wouldn’t all offices be in-network? Because some insurance plans are just plain lousy. To be profitable, the dentist would have to cut corners on your actual treatment or schedule you next to ten other people and you get to wait an hour to be seen.   People think that healthcare is immune to basic economic principles. It is not. In healthcare, just like everywhere else, you get what you pay for.

We are in-network with many plans that allow us to do top quality work at reasonable fees. But we are not in all the plans for the reasons above. We occasionally drop plans and add some plans. The nice thing about dentistry in the US is that you have to freedom (still) to see any doctor you want.  You may have to pay a little more, but if you like the doctor and staff, it’s well worth it.

In conclusion, if being in-network is very important to you, then ask, “Are you in-network?” In our office, this is sorted with the first phone call.

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