OK OK I know, you may have gotten the musical reference in the title. Yes, I also know that it may
have dated me! I am not afraid to admit that I am a child of the 80's.... and I love boy bands. NKOTB was my first love. If you're curious here is the official music video https://www.youtube.com/watch?v=A8LJKIyxmqM.
Who was your favorite in the group?? Mine was Joey....but I digress...sorry.
  Insurance can be a tricky bugger! How do you know what is what? Maybe your dentist just went "out of network" with your insurance. Maybe your employer changed plans? What now? All these questions can cause a lot of unnecessary worry. Let's break it down in simple terms. Â
 Firstly- there are two types of insurance plans open plans and closed plans. With open plans any dentist can submit claims to get the patient partially reimbursed for treatment. With closed plans (not many of these exist) only "in network" dentists can submit for reimbursement.  With that said, whats the difference between your dentist being "in network" or "out of network." This is determined based on if your dentist has accepted the customary restrictions and contracts that the insurance company has stated. These restrictions can be related to which patients they can treat, what the frequency for treatments are or what treatment options are available to patients in any given situation. Sometimes depending on the contract, being "in network" can create a scenario where your dentist will recommend the treatment that the insurance company dictates but that isn't always the best treatment for you.  For example: your child is in need of a lot of dental work. The insurance your employer has purchased on your behalf is in contract with your dentist. This contract does not allow the number of crowns be done as your child needs in one sitting. Your child needs to be sedated for treatment due to anxiety. You find out that  the insurance is dictating that the dentist must split your child's work into two visits, requiring a second sedation session. How would you feel about this if you were this parent? Wouldn't one visit with one session of sedation be ideal for your child's health? This is an extreme example, but a poignant one.
Secondly- With your doctor "out of network" does mean that you will end up investing a bit more than if they were "in netowrk." This is due to the write-off the "in-network" dentist takes to be contracted with that insurance, think of it as payment to insurance for advertising. However, Most people that need more intense dental work will hit their yearly maximum(500$-2000/year) and then from there they would be paying more anyways.
Ok, so I am saying if you LOVE your dentist but they are out of network you may want to consider staying because in the long run it may not cost you much more. Isn't your peace of mind worth it? BUT WHAT does that truly mean for your bottom line? It means that the insurance companies will most likely STILL reimburse you to some extent for your treatment. Yearly insurance limits have not increased since the 1970's and insurances have been decreasing the amount they pay out per procedure up to 30% over the past few years. The likelihood that if you need even a moderate amount of dentistry done is that you would max out your benefit anyways, regardless on if your dentist is IN network or OUT of network. Â
  It is my recommendation that when facing this choice, you consider how you want to have your oral health managed. The way a non-dentist dictates or the way your trusted and trained dental provider would recommend. Not all insurance companies are created equal, and this is a very watered down explanation for the purposes of demonstration.  No choice is wrong, but it is YOUR CHOICE to make. Â
  We encourage our patients to have conversations with our front office team should any questions or concerns arise.Â

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