We understand. There are some things about dental insurance that seem too boring and confusing to pay much attention to. At Beam®, we’re working to make the dental benefits space more innovative, more exciting, and less confusing for everyone, whether you’re a Beam® client or just want to learn more. Even I’ll admit that some parts of dental benefits are hard to get excited about, but it doesn’t mean we can’t make them easy to understand (and maybe even a little exciting).
So why should you care about networks in the first place? When you think about what matters in a dental plan for your company, you probably think of things like premiums, deductibles, and coverage levels. All of that is important, but without a great network, you wouldn’t be able to take full advantage of your dental benefits. Wondering why?
Here’s the short version of what you need to know:
- A network allows an insurance company’s members to access a large number of providers
- A provider joins a network to attract patients and streamline some administrative processes and accepts a price list set by the network
- Visiting an out-of-network dentist does not necessarily mean the service isn’t covered, but it might not be the same level of coverage you’d get from seeing an in-network dentist.
Still curious? Let’s dive in.
What is a network?
A network is an organization made up of a group of medical providers, in this case dentists. A dental insurance carrier uses a dental network to give clients of that insurance company easy access to a large number of dentists that will accept their insurance. In turn, dentists in the network gain access to a wider range of potential patients. Additionally, the network determines the fee schedule that the dentist can accept from an insurance company, which frees both the dentist and the insurance company from the administrative work of determining fee schedules for individual procedures.
To give an example, let’s say that XYZ Insurance partnered with the ABC Network. An XYZ Insurance member could visit any dentist in the ABC Network and receive care at in-network coverage levels (confused? see the previous post on dental insurance basics). This arrangement ends up being beneficial for everyone involved. The patient is offered their choice of a large number of dentists at in-network rates, while the dentist is able to attract patients with XYZ Insurance.
What happens if you visit a dentist that’s out-of-network on your insurance plan?
Does this mean insurance won’t cover the cost? Thankfully, there’s more to it than that. If you receive care from a dentist who’s considered out-of-network, there’s a chance that your insurance will cover a lower percentage of the cost than it would for an in-network dentist. For more details, the next post will discuss out-of-network coverage, but the short version is that insurance still covers you when you visit out-of-network dentists, but it might be at a reduced level, depending on your plan details.
Looking to learn more about networks? I’ll have more information available in the final part of this series.
This is the 3rd part of a four part series on understanding dental benefits for your small business. The final post will be released in the coming days.