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Do One Thing Well

Author: Christina Julian
April, 2016 Issue

There's a difference between "accepting the insurance" and being "in-network with the insurance." 

For many dental patients, dental insurance annual maximums replenish on January 1.  To make sure you get the most bang for your buck on your dental plan, we recommend you ask these three vital questions before having any upcoming procedures.

Are you in-network or out-of-network?

When you call your dental office, be sure to say: “I have XYZ dental insurance. Do you accept this?” Most likely, the kind receptionist will respond, “Yes, we do.” You have your appointment, and a couple of months later you receive a bill from the dental insurance company, showing that you owe a high percentage of the bill because the dentist was out-of-network.  Unfortunately, we see this happen far too frequently.  

There’s a difference between “accepting the insurance” and being “in-network with the insurance.”  A dental office may accept XYZ, when they aren’t necessarily contracted to provide care at the discounts received by an in-network dentist.  Thus, the insurance pays less and you may be responsible for the difference in cost. Further, a dental insurance company has different networks for a PPO (Preferred Provider Organization) and DHMO (Dental Health Maintenance Organization), and often has different networks (some bigger than others) that you may or may not have access to.  We recommend both calling your dental office and independently look on the insurance company website.  (The website is not always up-to-date, which is why calling the office to verify is a best practice.)  

It’s always a good idea to ask these questions up front: What is the cost of a new patient appointment? What is included? What should I estimate for out-of-pocket costs? Asking these questions will decrease the chance of a miscommunication and help ensure the dental insurance plan is paying the amount you expect from your plan.

Is there an alternate material that is less expensive?

Dentistry often offers multiple alternative procedures for treating oral-related disease and restoring teeth:  the costs for these options can be all over the place, but the outcomes are often equally effective.  Your dental insurance may only cover the least expensive method available, while your dentist may perform a more expensive alternative and you’re responsible for paying the difference in cost.  

All treatment options should be presented to you by your dentist. Some examples include: Would an inlay/onlay or a 3/4 crown be an acceptable alternative to a full coverage crown? Could a large filling be placed instead of a full crown? Are amalgam (silver/metal) fillings an option vs. composite restorations?

Be sure to ask your dentist about long-term expectations. Saving a little in the short-term for a less expensive treatment could result in higher costs and complications long-term.  Ask your dentist if a less-expensive alternative is appropriate and this could result in significant savings for you.

Is this treatment absolutely necessary?

To make the most informed decision, you should be aware of all your options, including what happens if you don’t have the procedure. You may not be experiencing any immediate pain or discomfort. You should be fully informed of what long-term issues you can expect to have when delaying or avoiding treatment.  Always ask for a comprehensive treatment consultation; your dentist should discuss alternate treatment options if feasible, as well as the urgency for completing treatment and the consequences of delaying treatment.  Depending on the procedure, seeking a second opinion is often a good idea and your primary dentist should support this decision: either to affirm the suggested treatment plan, or for alternate treatment suggestions that your primary dentist may not have originally considered.

Our Top Recommendation

Questions aside, the top recommendation that comes from our dental department?  Be your own advocate. Ultimately, it is up to you to know your plan’s limits and what is and isn’t covered.  Familiarize yourself with your dental plan’s benefits such as your deductible, what percentages are paid out, and your annual maximum benefit. Ask your dentist as many questions as you need to better learn about your dental care and what procedures may be best for you.

Born and raised in Petaluma, Stephen McNeil has been a principal and North Bay insurance broker at Arrow Benefits Group for more than five years. He earned his group benefits associate designation in early 2016 and is passionate about employee benefits and how it relates to his community. He can be reached at or (707) 992-3787.

Jennifer Wardell is a Northern California native and is the Director of Dental Operations at Arrow Benefits Group. A former Certified & Registered Dental Assistant for over twenty years, Jenn now focuses on assisting clients with self-funded dental administration. Jenn can be reached at or (707) 992-3774.


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