People in PPO plans can receive more coverage and benefits from in-network dentists. Though some people may go out-of-network to visit their preferred dentists, others may visit out-of-network dentists because they may live in rural areas or in areas where providers rarely participate in dental networks. Despite the decreased coverage with out-of-network dentists, dentists can still assure these patients, and any new ones, that they provide high-quality work. Processing out-of-network claims may differ from in-network claims, depending on the practice.
Excellent patient care
With decreased coverage, out-of-network dentists should provide excellent care and services. Since patients have higher copayments at these dentists, dental practices should provide pretreatment estimates so that patients can predict how much they will spend out-of-pocket for their procedures. While new patients may question going out-of-network due to higher copayments, the practice should assure them that they are committed to providing the best treatments and procedures. Furthermore, out-of-network dentists can recommend necessary treatment plans without worrying about any restrictions that insurance policies may place on them and the patients.
Handling out-of-network claims
Regarding out-of-network claims, dentists and patients may encounter some caveats. If the practice owner is in-network but the patient is treated by an out-of-network associate, the claim must list the associate as the treating provider and the owner as the billing provider. Consequently, the patient pays for the procedure as out-of-network, while the insurance company sends the reimbursement check to the billing provider. Furthermore, the practice can submit out-of-network claims for their patients either for free or for a fee. However, practices may leave the responsibility of claim submission to the patients. In this scenario, the practice may either balance bill the patient or expect payment in full before providing dental services, after which the insurance carrier reimburses the patient. While patients should send the claim with a copy of the bill or statement, the practice can help support their claim by sending any other necessary information, such as clinical notes or x-rays, to prove the necessity of the treatment for the patient. Without this information, the patient may experience a longer claim process and receive reimbursements later than expected.
Advantages of staying in-network
While out-of-network practices can provide quality care, staying in-network with insurance carriers offers several advantages for both dentists and patients. In-network dentists are included in insurance company directories, making it easier for patients to find them and increasing patient flow from those seeking lower out-of-pocket costs. Patients are more likely to return to in-network providers because they receive greater insurance coverage and fewer billing surprises. Additionally, in-network dentists avoid many of the claim complexities associated with out-of-network billing, reducing administrative burden for their teams. By staying in-network, dental practices can build stronger patient relationships, foster loyalty, and streamline claims processing, ultimately improving both patient satisfaction and practice revenue.
Out-of-network dentists can be confident that patients choose their practice based on trust and preference, but retaining those patients requires consistently exceptional care and proactive support with claims and billing. Navigating the complexities of out-of-network claims can be challenging and time-consuming, taking valuable focus away from patient care. That’s where eAssist Dental Solutions comes in. As the nation’s leading dental billing company, we help practices streamline claims processing, maximize collections, and reduce administrative burdens—whether you’re in-network or out-of-network. Schedule a consultation with eAssist today and let us help you simplify your billing while you focus on delivering outstanding care.
