Understanding Out-of-Network and Cash Benefits

Why should I consider an out-of-network provider or not using insurance at all? 

While insurance premiums increase annually, often a patient's benefits and amount of coverage stay the same. Similarly, the allocated amount an insurance company will pay a dentist for their services may stay the same, rise minimally each year (not in keeping with inflation/staffing costs), or even decrease. This means dentists who are in-network with many insurances may have to schedule “efficiently” with shorter appointments for procedures, choose less desirable materials/labs, work with more inexperienced team members and are unable to keep up with available technology. 

Would you prefer to decide what treatment is right for you, or do you trust an insurance company to choose? Despite availability of insurance benefits to a patient, insurance companies often try to dictate treatment decisions by either denying benefits because treatment does not fall under extremely specific parameters, or downgrading a proposed treatment like paying for a silver filling instead of a white filling. Many insurance-driven parameters favor reactive treatment, such as paying for a porcelain crown only when a tooth is grossly decayed or part of the tooth has completely fractured. In contrast, dentists often prefer recommending particular restorations before a tooth is extensively damaged with the intent of requiring less treatment overall. Our patients at Elite Dental Center often make informed decisions and choose to pursue recommended procedures, regardless of whether insurance will participate in paying their portion of benefits. However we have heard it time and time again from patients, “why am I paying for this insurance “coverage” in the first place?”. 

We encourage you to call your insurance company and learn more about your benefits, however keep in mind that insurance companies use scare tactics to train consumers that out-of-network providers are “bad”, more expensive and should be avoided at all cost. Their websites use language like, “beware of out-of-network providers,” and “avoid paying high out-of-pocket costs.”  They don’t explain that even with in-network insurance benefits, there will still be out-of-pocket costs, or that recommended treatment with an in-network provider could be downgraded or even denied by your insurance company, again leaving you with the cost. Most patients are surprised that their insurance will cover the same or a similar percent of coverage whether in-network or out-of-network. Patients may be responsible for only a small additional copay for out-of-network providers, but many find it worthwhile in exchange for the increase in time and quality provided. 

What are the benefits of paying cash (not using insurance) for dental treatment?

As mentioned above, insurance companies introduce a lot of hassle in trying to get procedures covered and confusion as to what a patients out of pocket costs will actually be. When paying in cash, you will have a clear understanding of your costs up front and can plan and save accordingly for the procedures you need. 

Not only that, but if you are a patient paying in cash, we are happy to offer a discount! Most dentists will offer a discount for patients paying cash since they don’t have the added overhead expense of filing insurance claims, dealing with denials or collecting for non-covered services.

Elite Dental has always been committed to delivering quality dental work and spending the necessary time with our patients to achieve the best results possible. We refuse to compromise how we deliver dental care, and so have chosen to change how we partner with insurance companies so our patients can receive the care they have come to expect.