When people hear that we're out-of-network, a lot of them assume their insurance won't help at all. That's rarely true. If you have a PPO plan, you almost certainly have out-of-network benefits, and many patients are surprised by how small the difference turns out to be. Here's how it works.
In-network vs. out-of-network, in plain English
An in-network dentist has signed a contract with your insurance company agreeing to charge its set, discounted fees. In exchange, the dentist gets listed in the plan's directory.
An out-of-network dentist hasn't signed that contract. They set their own fees, and your plan still pays benefits, just based on its own allowance instead of a contracted rate.
That's the whole difference. Your coverage doesn't disappear. The math just works a little differently.
How an out-of-network claim works, step by step
- You get a clear estimate. Before anything starts, you know the fee.
- We file the claim. We send it to your insurance company for you. No forms for you to fill out.
- Your plan applies its allowance. Insurers set an "allowed amount" for each procedure, usually based on what dentists in your area typically charge. You'll sometimes see this called UCR, for usual, customary and reasonable.
- Your plan pays its percentage. Many plans pay something like 80% for fillings and 50% for crowns. That percentage applies to the plan's allowed amount, not to our fee.
- You cover the rest. Your share is the difference between our fee and what the plan pays.
A quick example
Say a crown costs $1,400 and your plan's allowed amount for a crown is $1,200, covered at 50%. Your plan pays $600 and your share is $800. If the same plan allowed $1,400, it would pay $700 and your share would be $700. Deductibles and your annual maximum factor in too, and we include them in your estimate. (Illustrative numbers only; your plan will differ.)
Common myths about out-of-network dentists
- "My insurance won't cover anything." Most PPO plans include out-of-network benefits. HMO or DHMO plans usually don't, so it's worth checking which kind you have.
- "It'll cost way more." Sometimes a little more, sometimes about the same. Once your plan's percentage is applied, the gap is often smaller than people expect, especially for cleanings and exams that many plans cover at a high rate.
- "I'll have to do all the paperwork." Not here. We file your claims for you.
- "My annual maximum only counts in-network." Your annual maximum applies either way. It's the same pool of benefits.
Why we chose to stay out-of-network
Staying out of insurance networks is a deliberate choice. It lets us:
- Take our time. Network fee schedules push many offices to book more patients per hour. We'd rather give you an unhurried appointment.
- Recommend what you actually need. Your treatment plan is decided by you and your dentist, not by what a network contract favors.
- Keep our standards. We choose materials, labs and technology based on quality, not on what a discounted fee will cover.
Grand Parkway Dental Studios has served Sugar Land since 1984. Staying independent is a big part of how we've kept that kind of care consistent for four decades.
How we help you use your benefits
- We walk you through your benefits before treatment.
- You get a clear estimate up front, with no surprise bills.
- We file your claims for you.
- For bigger treatment, we can request a pre-treatment estimate from your plan and help you time care across plan years.
- We offer financing to spread larger costs into monthly payments.
Questions to ask your insurance company
- Do I have out-of-network benefits? (Most PPOs do. Most HMOs don't.)
- What percentage do you pay out-of-network for preventive, basic and major care?
- What's my deductible and annual maximum, and how much is left this year?
- Do you pay the dentist directly, or reimburse me?
Let's look at your plan together
The easiest way to know what you'll pay is to let us check. Call us with your insurance info, or request a visit and we'll walk you through your benefits before your first appointment. Planning something bigger? See what dental implants cost in Sugar Land.