Insurance and Billing
Out-of-network dentist
An out-of-network dentist has no contract with your dental plan. The plan may pay less or nothing, and you may owe more of the bill.
An out-of-network dentist is one who does not have a contract with your insurer. HealthCare.gov calls this a non-preferred provider and says you will pay more to see one. NADP adds that you usually pay more out of pocket for out-of-network care.
What happens next depends on your plan. A PPO may cover part of the cost. A DHMO usually covers none outside the network. An out-of-network dentist may also bill the difference between the fee and the plan's allowed amount. This is called balance billing.
Before you book, ask your plan how it treats out-of-network care. Ask the dental office for an estimate. A pre-determination can also show what the plan expects to pay. See in-network dentist.
Related terms
- In-network dentist
- Balance billing
- PPO dental plan
- DHMO (dental HMO)
- Usual, customary and reasonable (UCR) fee