Kitsap Kid's Dentistry

In Network vs Out of Network Insurance; What’s the Big Deal, and What’s the Difference?

In regards to your insurance, you have probably heard the terms “in-network” and “out-of-network” thrown around quite a bit. But what do these terms actually mean, and more importantly what do they mean for you?

Our office is “in-network” with five insurance companies: Metropolitan Life (MetLife), United Concordia (and members of the United Concordia Alliance), Regence, Delta Dental (and Washington Dental Service), and DSHS (Medicaid). Being “in network” means that our office has signed a contract with the above insurance companies. In that contract, every procedure code our office uses has been reviewed with the insurance company, and our “in network” contract with that insurance company stipulates that we will not bill more than a certain, agreed upon amount, for a procedure. It also means that we agree that we will not bill less than the contract stipulates. The difference between the agreed upon amount in the contract and our office fee (the full fee for the procedure) is written off, and the parent is not responsible for it.

Sometimes parents believe that because they have elected to bring their kiddos to an “in network,” “contracted,” or “preferred” provider, that they will have no patient responsibility as far as co-pays. It is important to understand that that is usually not the case. Deductibles and standard co-pays are still the responsibility of the patient, and must be met before any insurance benefits are payable. Additionally, each parent has signed their own contract with an insurance company, which stipulates the percentage that will be covered for a procedure (for example, preventative covered at 100%, basic procedures (like a filling) covered at 80% etc) and sometimes the maximum amount allowed for a procedure. If the maximum amount allowed for a procedure in a parent’s contract is less than the maximum allowed amount in our office’s contract with an insurance, the difference between the two is patient responsibility.

Not all patients who come to our office are registered with an insurance contracted by our office. In fact, we see tons of patients who come without insurance at all, or who come with an insurance that our office has not contracted with. For those kiddos, their parents will be responsible for the difference between our office fee and the amount covered by their insurance plan. There is no write off. The good news, however, is that our office is not required to limit care for kiddos without a contracted insurance, which means anyone can come here for their dental care.

It is important to understand the differences between in-network and out-of-network providers before choosing which dentist or doctor is right for you. Check with your insurance company to see which providers in your area are in your plan’s network. If you have any questions about your child’s dental insurance coverage, or want more information about enrolling with a contracted insurance, please do not hesitate to check out our office billing webpage at http://kitsapkidsdentistry.com/office-policies.php?mode=desktop, or call our office 360 698 3242. We love to help patients’ families understand and make the most of their benefits. We are excited to hear from you!

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In Network vs Out of Network Insurance; What’s the Big Deal, and What’s the Difference?

In regards to your insurance, you have probably heard the terms “in-network” and “out-of-network” thrown around quite a bit. But what do these terms actually mean, and more importantly what do they mean for you?

Our office is “in-network” with five insurance companies: Metropolitan Life (MetLife), United Concordia (and members of the United Concordia Alliance), Regence, Delta Dental (and Washington Dental Service), and DSHS (Medicaid). Being “in network” means that our office has signed a contract with the above insurance companies. In that contract, every procedure code our office uses has been reviewed with the insurance company, and our “in network” contract with that insurance company stipulates that we will not bill more than a certain, agreed upon amount, for a procedure. It also means that we agree that we will not bill less than the contract stipulates. The difference between the agreed upon amount in the contract and our office fee (the full fee for the procedure) is written off, and the parent is not responsible for it.

Sometimes parents believe that because they have elected to bring their kiddos to an “in network,” “contracted,” or “preferred” provider, that they will have no patient responsibility as far as co-pays. It is important to understand that that is usually not the case. Deductibles and standard co-pays are still the responsibility of the patient, and must be met before any insurance benefits are payable. Additionally, each parent has signed their own contract with an insurance company, which stipulates the percentage that will be covered for a procedure (for example, preventative covered at 100%, basic procedures (like a filling) covered at 80% etc) and sometimes the maximum amount allowed for a procedure. If the maximum amount allowed for a procedure in a parent’s contract is less than the maximum allowed amount in our office’s contract with an insurance, the difference between the two is patient responsibility.

Not all patients who come to our office are registered with an insurance contracted by our office. In fact, we see tons of patients who come without insurance at all, or who come with an insurance that our office has not contracted with. For those kiddos, their parents will be responsible for the difference between our office fee and the amount covered by their insurance plan. There is no write off. The good news, however, is that our office is not required to limit care for kiddos without a contracted insurance, which means anyone can come here for their dental care.

It is important to understand the differences between in-network and out-of-network providers before choosing which dentist or doctor is right for you. Check with your insurance company to see which providers in your area are in your plan’s network. If you have any questions about your child’s dental insurance coverage, or want more information about enrolling with a contracted insurance, please do not hesitate to check out our office billing webpage at http://kitsapkidsdentistry.com/office-policies.php?mode=desktop, or call our office 360 698 3242. We love to help patients’ families understand and make the most of their benefits. We are excited to hear from you!

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