It can be difficult to understand the real differences between In-network and Out-of-network dentists, with regards to dental insurance coverage you may have.  In-network dentists agree to terms and conditions set forth by insurance companies.  The insurance company can actually decide what types of procedures the In-network dentist can do for patients covered under their plan.  The insurance company can deny payment, or require the dentist to downgrade treatment as diagnosed for the patient because the insurance company deems it unnecessary (even if the dentist believes it is the best line of treatment, and will result in the best outcome for their patient).  In addition, In-network providers agree to fees for their services set forth by the insurance company.  They agree to take whatever payment the insurance company is willing to provide.  Most often, this insurance “reimbursement” is far less than the value of the procedure, the dentist’s time, and materials used.

Out-of-network dentists refuse to allow insurance companies to dictate how they will treat their patients.  They choose not to sign up with insurance companies, because they do not want the restrictions In-network dentists must conform to.  Out-of-network dentists are free to do what is best for the patient.  They diagnose and treat with only the patient’s best interest in mind.  They don’t have to stop and wonder if the insurance will allow a certain procedure.  They are unencumbered by stipulations set forth by insurance companies.  Therefore, Out-of-network dentists are able to use the best materials and techniques, ensure the best cosmetic outcome for your smile, and spend much more time with patients.  Only you, the patient, and your dentist, know the issues you have, the sensitivity you may be feeling, and the look you want to achieve, so only you and your dentist can determine what line of treatment is best for you.  Out-of-network dentists provide a one-of-a-kind experience.  In-network providers tend to lean toward more of a cookie-cutter, one-size-fits all experience for their patients, because that is least time consuming, and cheapest for the insurance company.

If you visit a dental practice that is In-network, you will probably pay as little out of pocket as possible. That’s because the dentist has contracted with your insurance company to controls prices.  The disadvantages are that this contract tends to control the methods and materials these dentists use for treatment, which can contribute to less-than-ideal care.  In-network dentists may take on quite a few patients in order to meet financial goals. This might mean they are very busy, and do not always have time to spend necessary time with patients one-on-one, to provide the best treatment possible.

You will probably pay slightly more at an Out-of-network practice. However, Out-of-network dentists are free to provide the care that they feel is best for patients, not the care an insurance company tries to dictate.  Out-of-network dentists are able to provide more personalized, comfortable care.

Most consumers believe that if you see an In-network dentist, you pay nothing for your appointments.  This is not always the case – every insurance plan has many rules and stipulations for coverage.  For example, some work on a fee schedule meaning that they will pay only a percentage of a service.  Others provide annual benefits, meaning that they have a set maximum amount they will pay toward dental care in one year.  Some only provide coverage for preventative appointments, and most have deductibles that have to be met before the insurance company pays for any services.  Always read the fine print and ask questions before signing up for dental insurance, so you understand the coverage and can be prepared.

Insurance companies sometimes use scare tactics to make consumers think Out-of-network providers are “bad” and more expensive.  Their websites use language like, “beware of out-of-network providers,” and “avoid paying high out of pocket costs.”  They don’t explain that even with insurance, you will still have out of pocket costs, and that your treatment could be downgraded or even denied by your insurance company.

Many patients do not realize that their In-network Dentist is accepting less money for doing their dental work.  Many of these In-network dentists use less expensive labs and/or materials.  High quality dental offices like Dr. Galaif do not make purchasing decisions based on a dollar amount – if materials, equipment and/or labs and other referred doctors are good for our patients or our practice, then we make the purchase, contract with the lab or offer a referral.  Dr. Galaif uses the highest quality materials and the best labs.  The dentistry we provide to all of our patients is the dentistry we would want in our own mouths, those of our children, parents, relatives and friends.  We use the latest and most cutting-edge technology to enhance our patient’s experience and comfort, which can be very costly in some cases.  We use computers to deliver anesthetics.  We have an air abrasion machine to do small fillings, without drilling or Novocain.  We have a CAD CAM system so we can make crowns right in our office, during a single visit, which eliminates the need for temporary crowns to be replaced later on subsequent visits, after waiting for labs to prepare and deliver them.

Dentist who accept lower fees are not able to purchase these items or utilize such technology.  Some In-network dentist use a less expensive lab for their low fee insurance patients, and a higher fee lab for their higher fee patients.  We use the same lab for all of our patients, contracting with specialty labs for each and every procedure need – we have separate implant labs, night guard labs and denture labs.  Some dentists buy off-market implant parts.  We only buy parts directly from manufacturers.

When you visit Dr Galaif for your appointment, you will notice that we always spend quality time with our patients – from the front office staff who greet you, assistants, hygienists and Dr. Galaif himself.  We work very hard on our schedule to ensure that our patient’s do not have to wait.  We do not run from room to room.  Dr. Galaif schedules new patient exams and consultations so that he can spend at least an hour with you.  In-network dentists cannot afford to offer this level of service, nor spend this amount of time with each patient because they are getting paid much less and need to do more volume.

Dr. Galaif only hires the best staff available, and the highest quality staff comes with associated costs.  We have amazing people who answer the phones, incredible assistants, and the best, most well-trained hygienists.

For any dental needs, especially complex or cosmetic procedures, it’s a good idea to choose a dentist who will suit your needs and is an expert in the field.  With that in mind, you may want to see an Out-of-network provider to ensure the highest quality treatment.  You can also find out if you might still be able to use your insurance plan, to get your insurance company to reimburse certain payments to you.

Please be aware when making insurance decisions that you are going to get what you pay for.

Call us to make an appointment for the highest quality dental care at (818) 789-6789, or visit the appointment page on our Web site:

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