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Please answer a simple question for me: if I choose a dentist not in my network, will the insurance pay them? My dentist's office informed me that they are not under contract with Aetna, my current insurance provider, but that they will bill them. I like my dentist and don't want to change, but if my insurance won't pay, then I can't afford to keep him. When I talked to Aetna they "strongly suggest"-ed that I choose an in-Network provider. But my current dentist has been very good to me and even saw me on emergency for free, so I really want to give him my business if I can.
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Depends on the plan of course, but typically the insurance company will cover a percentage of the "reasonable and customary" charges. You'll get dinged in 2 ways: The reasonable and customary charges are usually lower than what the dentist charges, and the insurance company only pays a percentage (say, 70%) of that lower amount.
If you really like your dentist though, it could be worth paying more out of pocket.
Some dentists require you to send in the claim form; others will submit a claim form on your behalf. -
As sweeps said it depends on the plan so check that.
There should be a clear area in your dental plan description for out of network (OON) benefits.
My OON dental benefits are almost the same as in-network - preventive is 80% OON 100% in-network all other benefits (orthodontia, crowns, fillings, etc.) are paid the same.
I have also seen many dental plans that have no out-of-network coverage.Comment
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