Using Dental Insurance at a Fee-for-Service Dentist
What fee-for-service means, how out-of-network dental benefits reimburse you, and three questions to ask your insurer before your visit.
Dr. Edward J. Filangeri, DDS. Published
Our office is fee-for-service, which surprises some people who assume every dentist is “in network.” Here is what it means, and how your dental plan can still help pay for your care.
In network and out of network
An in-network dentist has signed a contract with an insurance company. The contract sets the dentist’s fees for that plan’s members, and the plan’s rules shape what is covered and how often.
A fee-for-service dentist has not signed those contracts. The practice sets its own fees, and treatment is decided between you and the dentist. Dr. Ed practices this way because it lets him recommend what your teeth need, take time to explain it, and be straightforward about what can wait.
How your plan still pays
Many dental plans, especially PPO plans, include out-of-network benefits. In that case:
- You pay the office for your visit.
- You get an itemized statement listing the procedure codes your plan asks for.
- Your plan reimburses you for its share.
How much comes back depends on your plan’s out-of-network percentage and its “usual and customary” fee for each procedure. Preventive visits such as exams, cleanings and x-rays are often covered at a higher percentage than larger work.
Some plans, especially HMO or DHMO plans, pay nothing outside their network. It is worth checking which kind you have.
Three questions to ask your insurer
Call the member services number on your card and ask:
- Do I have out-of-network dental benefits, and what percentage do you pay for preventive, basic and major care?
- What is my annual maximum, and how much of it have I used this year?
- Is there a deductible, and do I need pre-authorization for crowns or other major work?
Write the answers down and bring them to your visit. If anything is confusing, call us at 631-588-9041 and we will help you make sense of it.
No insurance at all?
You are in good company, and you still have options. Our Smile Club membership covers two cleanings, two exams and a set of x-rays each year for one yearly fee, with a discount on other care. And whatever your situation, you get the fee before any treatment starts.
