Out-of-Network Dental Care
What out-of-network really means, and why it often leads to better, more personal care.
Hearing that a dentist is out of network can sound like a drawback, when in reality it often means better, more personal care. Understanding how it works can save you stress and help you make a confident choice for your smile.
At Encore Dentist, we are an out-of-network practice by choice, and we want you to understand exactly what that means for you. Being out of network does not mean you cannot use your benefits, and for many patients the experience is better, not more expensive.
What Out-of-Network Really Means
Out of network simply means we do not have a contract that lets an insurance company set our fees or dictate your treatment. In-network dentists agree to an insurer's pre-negotiated rates and rules in exchange for being listed in a directory. We have chosen not to, so that we answer to you. In practice, that often means longer appointments, more time with your dentist, and recommendations based only on what is best for your health.
In Network Compared With Out of Network
The table below summarizes the practical differences for you as a patient.
| What matters to you | In network | Out of network |
|---|---|---|
| Who sets the fees | The insurance company | The dental practice |
| Treatment recommendations | Limited by the insurer’s rules | Based on what is right for you |
| Provider choice | Limited to the network list | Any dentist you choose |
| Using PPO benefits | Applied directly | Usually reimbursed to you after a claim |
| Time with your dentist | Often shorter | Typically longer and unhurried |
How to Use Your PPO Benefits With Us
If you have a PPO plan, you almost certainly have some level of out-of-network coverage. Your insurer pays a percentage of what it considers a usual, customary, and reasonable fee for your area, and you are responsible for the difference, which is known as balance billing. Knowing this in advance lets you plan with no surprises.
- Review your plan’s out-of-network deductible, coverage percentage, and annual maximum, or ask us to help.
- We provide an itemized estimate with procedure codes before treatment.
- You receive care, and we help you submit the claim to your insurer.
- Your insurer reimburses the covered portion based on your plan.
Why Out of Network Can Mean Better Care
Without an insurer’s restrictions, we are free to recommend the materials and treatment we believe are best, spend more time with you, and build a long-term relationship rather than meet a quota. Many patients find that continuity with a dentist who knows their history is worth more than staying strictly inside a network.
Cost is still the most common reason people delay care, and the Centers for Disease Control and Prevention reports that roughly a third of adults did not have a dental visit in a recent year. We work to remove that barrier with clear estimates, financing, and a membership plan.
Making Care Affordable
We believe quality care should be within reach. For patients without insurance, or whose benefits have run out, we offer flexible financing and an in-house membership plan that includes preventive care and savings on other treatment.
Frequently Asked Questions
Will my insurance cover any of the cost if you are out of network?
In most cases, yes. Most PPO plans offer partial reimbursement for out-of-network care, though the amount depends on your plan.
Do I have to pay the full amount up front?
Often you pay at the time of service and then receive reimbursement from your insurer after the claim is processed. We will explain your options before treatment.
What is balance billing?
It is the difference between our fee and the amount your insurer considers usual and customary. We provide an estimate in advance so you know your expected out-of-pocket cost.
What if I do not have any dental insurance?
You still have good options. Our in-house membership plan and financing make consistent care affordable without a policy.
Talk With Our Team
Out-of-network care gives you freedom, flexibility, and a dentist who answers to you. If you have questions about your specific plan, our team is glad to help with no pressure.
Contact Encore Dentist, and we will walk you through your benefits and options before your first visit.
