Vision Dental Mar Vista

What does "out-of-network" mean?

Insurance companies negotiate agreements with dentists to have a certain set of fees for dental procedures. The dentist will lower their fees for a given insurance company, and in exchange, the insurance company will advertise this dentist as an “in-network provider.” The patient gets the benefit of lower fees, and to use their insurance coverage (which usually covers procedures at 40 percent to 80 percent depending on which procedure). 

Insurance companies will pay part of procedures when a patient visits a dentist “in their network.” What is less commonly known is that most insurance companies also have “out-of-network benefits.”

This means that if the patient visits a dentist NOT in the insurance’s network, the patient will still get insurance payment coverage on procedures. Thus, when a patient visits an out-of-network dental office, their dental procedures will still be paid for in part by their insurance company. 

For the vast majority of cases, whether a patient visits an in-network dentist or out-of-network dentist, they will still have to pay a portion of the procedure. Patients who visit an out-of-network dentist, like our office, pay a small amount more. 

Our office fees are based on the “UCR,” or usual and customary rate, for our zip code. Being out of network allows us to schedule more time with our patients and helps us provide the highest level of service.

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