What Does it Mean to be an Out-of-Network Provider

Categories: General Dentistry


Recently, Ebrahimian Integrative Dentistry became an out-of-network provider with Delta Dental. While this may sound like a bad thing if you have Delta Dental, we believe it will ultimately mean better care and long-term oral health for our patients. Here’s why we think you’ll benefit from this change.

Dental insurance policies are expected to help cover the cost of dental treatment, saving you money. But did you know that dental insurance actually limits your care? Dental insurance is the only type of insurance available that doesn’t take into account your oral health status, or history. Whether you sign up for a policy through your employer or take out an individual policy, you don’t have to answer any questions about your oral health or overall health in order to get coverage. Additionally, insurance that covers your home, automobile, or even medical care shares a significant portion of your overall costs to rebuild, repair, or treat what is covered by your policy. However, dental insurance does not work in this way. In fact, most dentists don’t even consider it as actual “insurance” but more of a prepaid benefits plan because they pay very little and have a low annual maximum that they are willing to pay toward treatment.

For instance, most dental plans have a 100/80/50 split in terms of coverage. The 100% coverage typically applies to preventive care like cleanings, exams, and x-rays. Basic care, like fillings, extractions, or gum disease treatments may be covered at 80%, and crowns, bridges, and dentures fall under major care that’s covered at 50%. While this may sound like a good policy to have, these coverages have an annual maximum that the insurance will cover, which can be between $1,000 and $2,000, and most policies have an exclusions list which get them out of paying for a lot of care to begin with. An example of an exclusion may be that the insurance plan won’t cover their portion of a crown if you recently had one done on that same tooth. Or if you had a tooth pulled before you took out your current dental insurance policy, then it won’t cover any cost to replace that tooth. Some dental insurance policies also will not cover all-porcelain restorations or metal-free fillings, which are more aesthetic to the eye and healthier options for patients.

What does out-of-network mean?

Being an out-of-network provider doesn’t change anything in terms of the quality of care that you receive. And we still will submit claims to Delta Dental on your behalf. But going forward, patients with Delta Dental insurance will be asked to pay for the entire cost of their treatment out-of-pocket at the time of their visit. After we file your claims with Delta Dental, we will reimburse you any amount that they pay on your behalf, according to their policy coverage amounts. For instance, if your treatment costs $200, you’ll pay that amount during your visit. We’ll file the claim with Delta Dental, and if they cover $50 of that treatment, we will mail you a check to reimburse you the amount that your insurance paid. Additionally, we will ask that you sign a waiver that acknowledges your understanding of this change and agreement to pay your balance in full at the time of service.

Why this change is good for you

At Ebrahimian Integrative Dentistry, we believe that dropping Delta Dental as an in-network provider is beneficial to patients with this insurance plan because you’ll now have the freedom to choose the treatments that are best for you. You’ll no longer be bound to opting for or forgoing treatments because of your insurance plan. Furthermore, since dental insurance focuses more on fixing what’s broken and less on the mouth and body connection, you’ll likely experience improved long-term oral health since your care won’t be limited.

Additional payment options

Our premier dentists in Scotts Valley believe that cost should never be a barrier to care. Therefore, we accept CareCredit to help patients pay for the cost of their treatment at the time services are rendered. CareCredit allows you to pay for treatment and then make zero interest, low monthly payments to spread out the cost of your care. Qualifying for CareCredit is easier than with most credit cards. You can also use this credit at more than 260K other providers across the country for medical, veterinary, optical, and  pharmacy costs, as well as for select retail products that qualify.

Receive the Best Dental Care in Scotts Valley, Los Gatos, and Santa Cruz, California

Insurance changes can be difficult to navigate, and we don’t want you to feel alone on that journey. We also want to iterate that whether you have dental insurance or not, you’ll always receive the exceptional dental care at our practice that you deserve. If you would like to learn more or have questions about how this recent change will impact you, please contact Ebrahimian Integrative Dentistry by calling (831) 438-4411.