Patients often ask why our office isn’t in-network with dental insurance plans. The short answer? It’s about protecting the quality of care you receive.
Our decision to remain out-of-network is not about refusing insurance – we gladly work with PPO plans and help patients make the most of their benefits! Instead, it’s about maintaining transparency, clinical autonomy, and a standard of care that isn’t dictated by insurance companies.
The Freedom to Choose the Care You Deserve
Being out-of-network means we aren’t limited by the restrictions insurance companies place on in-network providers. This gives us the freedom to:
- Use high-quality materials and advanced technology.
- Spend more quality time with each patient.
- Recommend treatment based on your needs – not insurance limitations.
We believe each patient deserves personalized, uncompromised care, and that’s only possible when we’re not bound to insurance-imposed fee schedules and limitations.
In addition, you have the freedom to choose the provider you feel most comfortable with rather than choosing from a limited list of doctors.
You Can Still Use Your Insurance Benefits!
If you have a PPO plan, you can absolutely utilize your benefits at our office, as these plans typically include out-of-network coverage. We help make the process seamless by:
- Providing a detailed pre-treatment estimate before your visit (upon request).
- Submitting claims on your behalf.
- Going over your treatment plan in detail and providing a comprehensive explanation of your expected out-of-pocket costs clearly.
It is important to note that certain insurance plans do not offer coverage for out-of-network providers. This includes most HMO plans and state-funded plans such as Medicaid.
How Dental Insurance Actually Works
Unlike medical insurance, dental insurance plans don’t have an out-of-pocket maximum – instead, they have a yearly benefit maximum, often around $1,000-$1,500. Once that amount is reached, your plan stops paying, regardless of the procedure.
Did you know – in the 1970’s, the average dental insurance maximum was around $1,500, which would be equivalent to over $7,000 today. Yet, in 2025, the average dental insurance maximum is still $1,500!
Coverage percentages (like 100% for cleanings, 80% for fillings, etc.) are typically based on your insurance plan’s fee schedule, not our actual office fees. For example, if your plan’s allowed fee for a procedure is $50 and they claim to cover it at 100%, then they will cover $50 at 100%. Now, if the fee for that procedure is $100, an in-network office would be required to write off the remaining balance, whereas an out-of-network office simply collects the remaining $50 from the patient.
Why More Dentists are Going Out-of-Network
We’re not alone in this decision. In fact, more and more dental offices around the country are stepping away from insurance networks in order to better serve their patients. According to a 2023 survey by the ADA, dental offices that have dropped insurance networks cited the following reasons:
- Low reimbursement rates – 59%
- Administrative burden – 24%
- Insurance limitations on treatment options – 11%
- Other reasons (scheduling control, autonomy, values) – 6%
Additionally, in a 2024 survey by the ADA, 98.7% of dentists who left insurance networks cited insufficient reimbursement as a major reason.
In-network offices are ultimately left with two options: shorten appointments and increase patient volume, or reduce the quality of care to meet financial constraints. We choose neither.
Does Seeing an Out-of-Network Provider Make Treatment More Expensive?
Not necessarily, and not in the way many people think.
Insurance companies often promote the idea that staying in-network will save you money, but this isn’t always the case. In reality, the cost of dental treatment is dependent on your specific insurance plan – and some plans offer coverage that results in little to no difference in your out of pocket costs.
The most important thing is having accurate information up front. That’s why we happily provide detailed estimates and help you understand how your benefits can be used, making sure there are no surprises for you.
The Business Behind Dental Insurance
Dental insurance companies operate as for-profit entities, and a significant portion of premium dollars often goes towards executive compensation.
For instance, in 2024, the CEO of a popular dental insurance company received a total compensation of $20.3 million. For the third quarter of 2024, that same insurance company reported net income of $1.3 billion (not revenue – profit). Meanwhile, a 2023 study found that roughly 21% of individuals with employer-sponsored insurance plans reported denied claims.
While insurance companies are bringing in billions of dollars in profit, in-network practices write off an average of 45% to 55% of their gross production due to their insurance contracts. For example, an in-network practice generating $1,000,000 annually with 80% of their patients on contracted plans may write off approximately $600,000 each year.
This approach helps keep insurer profits high, but it can lead to delays, denials, or reduced coverage for the care that you’re counting on. Understanding how dental insurance companies operate is vital in understanding why many practices choose to operate without insurance contracts in place.
The Bottom Line
We remain out-of-network because we believe in doing things the right way – for the sake of our patients, our team, and the longevity of our practice. Our priority is quality care, comfort, and long-term relationships – not cutting corners to comply with insurance regulations.
And yes – you can still use your insurance here.