We understand. 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 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).
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 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. They accept 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 benefits carrier uses a network to give clients 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. 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. Out-of-pocket costs will depend on whether the plan has a MAC (Maximum Allowable Cost) or UCR (Usual Customary Reasonable) reimbursement, which you can read more about here.