Dental Insurance: What Does Out-of-Network Mean for You and Your Dental Needs

Some of our Glassman Dental Care Patients have dental insurance, yet we are considered Out-of-Network providers. What does that mean to our patients with insurance?

85 Million Americans lack Dental Insurance (The Washington Post, August 2013). For people who do have dental insurance through their employers, they receive a yearly maximum and are typically allowed 2 cleanings/2 exams/one-set of x-rays a year that is deducted from the yearly maximum. Additional services are paid in percentages (ie: crown at 50%, filling at 80%) and the patient is responsible for the yearly co-pay, the percentage not covered by insurance, and whatever falls outside of the yearly maximum. For anyone needing any dental work, outside of cleanings, understand that you will be paying for the majority of the dental work out-of-pocket.

As an out-of-network practice, patients still receive the same benefits from their insurance company, however, the patient is responsible for paying for the services up-front and submitting the paperwork to be reimbursed for the cleanings or dental work. More about that later.

There are many insurance practices in and around New York City. Here are some of the characteristics of an insurance practice:

  • Dentists who are extremely busy since many patients find them not through their skill set and recommendations, but through the insurance company website;
  • Treatment is mostly single-tooth treatment;
  • Insurance offices typically take on associates to deal with packed schedules and the high volume;
  • Appointment books are full 2-4 weeks in advance;
  • There is typically a higher staff turnover.
  • Our patients come through word-of-mouth;
  • New and existing patients can be seen the same week they call;
  • Treatment is more comprehensive;
  • We are patient-focused versus procedure-focused.

At Glassman Dental Care:

What does patient-focused versus procedure-focused mean?

Example1: We had a patient who moved to upstate New York and found an insurance-based practice in her new city. On her first visit to the new office, the dentist told her she had a few cavities that needed immediate attention. She had two cavities filled, but found herself in pain afterward. She called us and made an appointment to see Dr. Steven when she came down to see family. Upon examination, Dr Steven told her that she did not have significant decay in those teeth and did not need the fillings. At GDC, those teeth would be “watched” versus treated. However, many insurance practices have high insurance write-offs and lower profit margins so they have to push through treatment that might not always be in the patient’s best interest.

Example 2: We have had a few patients who have left the practice to get cleanings at insurance practices. 95% of those people return. Why? A dental cleaning at Glassman Dental Cleaning typically lasts 50 minutes and includes “definitive” (hand) scaling, cavitron, hand polishing, and time to educate each patient regarding how to better care and maintain their smiles. In an insurance practice, the cleanings are done in less time, with a cavitron, and a prophy jet (combination baking soda and water which is blasted on teeth) is used for the cleaning and polishing – and there is no time for patient education.

Example3: There was a patient who wanted to have Invisalign at our office, but wanted to use her insurance provider to take care of some fillings that Dr Glassman had advised taking care of prior to placement of the first aligners. The insurance practice only did one filling because the others were over her yearly maximum.

Example 4: A patient who had a 2-surface filling got treated for a crown instead, since the crown pays a higher premium to a practice that is concerned with maintaining certain profit margins.

So, again, back to the original question: What Does Out-of-Network Mean for You and Your Dental Needs?

At Glassman Dental Care, we vow that your dental needs are paramount to us. We will never under- or over-treat your teeth. If you need an appointment, you will be seen as soon as possible (for emergencies, it will be same-day!), the hygienists will spend time both cleaning your teeth and educating you regarding factors that could be contributing to poor oral health, and both Dr Steven and Dr Debra have been known to personally respond to emails – even on weekends.

And if you do have dental insurance, the front desk will help you submit your paperwork so that you will get reimbursed for procedures, and we can help you get any pre-determinations so that you know what your out-of-pocket will be before you undertake new work.

Ultimately, the best way to come out ahead on dental expenses is to brush and floss regularly, get professional cleanings as often as is recommended, and going to dentists (like Dr Steve and Dr Debra) who do high quality work that lasts for years. This is the most effective way to save money in the long run.