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The difference between contracted and non-contracted dentists

There’s lots of confusion when it comes to insurance benefits, contracted and non-contracted dentists and what those things actually mean to you as a patient. Non-contracted dentists are dentist that possibly accept/file your insurance claims however they are out of network. When a dentist is out-of-network or non-contracted it means that you are responsible for your percentage of the dentists actual fee’s. (Example: Dr Anderson charges $100 for a filling and your insurance company pays 80%, you as the patient would pay $20 and your insurance company will reimburse Dr Anderson $80). Sometimes patients have been seeing their same dentist for many years but let’s say that he/she has decided to drop your insurance at the beginning of the upcoming year, how will this affect you? Some patients don’t mind spending a little extra money knowing the environment and  comfort level with not only the dentist but also the office staff and then there are certain situations where patients have to save money everywhere they can so when the dentist switches they will have to switch as well. Everyone’s situation is different so it’s up to the patient to decide what the best option for them will be.

What does it mean to be a contracted dentist? When a dentist is contracted or in-network with your insurance company your dentist has worked closely with the insurance company to come up with a reduced fee that’s lower than the office’s full fee or sticker price if you will which then makes the patients responsibility lower than than if you went to a dentist that was out of network or non-contracted. (Example: Dr Anderson charges $100 for a filling but he and the insurance company have agreed to only charge the patient $80 so you as the patient would pay $16 and the insurance company will reimburse Dr Anderson $64). Most dentists in the Kansas City area are contracted with your standard PPO plans however there are still a few that are not.  We always recommend that you follow-up with your insurance company to make sure that the dentist is in your network unless you are prepared to pay extra or we as the dentist can let you know as well just with a simple phone call.

There are lots of different insurance companies and every dental plan is designed specifically for you and your group so unless two people work for the exact same company and have the exact same group number, their benefits will more than likely be different. If you have any questions at all regarding your benefits please contact Lacie at 816-454-3336.

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