If you haven’talready, we recommend reading our previous post about the differences between adental office being in-network vs out-of-network with a specific dental plan.

People may wonder why certain dentists are not in-network with their plan, or are deciding to go out-of-network with a plan that they used to be in-network with. As shown in the previous post, there is a lot of variation amongst the hundred of dental plans out there, and each may reimburse different amounts for the same procedures. Most dental contracts have not raised the discounted fees in over adecade (and some have even lowered them!). This means that as the costs of delivering services have gone up (staff wages, building lease, supplies, etc),the financial reality is that it may no longer be possible to provide these services at a high quality while still accepting reimbursement levels that were initially agreed upon over a decade ago. While most businesses can raise their rates to account for inflation and their increased costs, as long as a dental office is contracted with a specific insurance carrier, their reimbursement is dictated by that insurance company. Any increase in fees by the office will only affect those patients without dental insurance or with out-of-network plans.

In an ideal world, insurance companies would adjust and increase their maximum allowable fees and reimbursement levels to keep up with inflation, much the same way that they increase the wages for their own employees and executives by increasing the premiums that they charge their subscribers. The decision to go out-of-network with a plan is not one we take lightly. We have formed bonds with our patients and enjoy seeing them at their regular visits. We want to continue taking care of our patients at a high level and we feel it is important for us to do the following:

· Be able to spend ample time with them answering their questions and not feel rushed

· Investing and using the latest technology and best materials

· Give our team members annual raises

· Take continuing education courses to stay up-to-date with best practices

· And not recommending unnecessary procedures just to keep up with inflation.

In order to do these things and be able to adjust our fees to keep up with costs, we may need to end our contracted relationship with a certain insurance provider. With almost all dental plans, you can continue to see your provider even if they are out of network, and your insurance plan will still reimburse a portion of that visit- it will just likely mean that your insurance company will now be reimbursing the dental office a higher amount than they used to, and that you may owe a balance. We thank you for your understanding and welcome any questions you may have.