Whether to opt to be an in-network practice or out-of-network with practice dental insurance is a dilemma faced by every dentist looking to start a brand new dental practice. Both options are different from each other and affect the claims and billing process of practices differently. So, whether to choose to be in an in-network practice or out-of-network is a matter of considering what is going to work the best for your practice and the people or service you plan to hire in order to handle that process.
Here we will walk you through the pros and cons of your practice being in-network versus out-of-network with insurance, while at the same time helping you understand the benefits and drawbacks of each option.
To start with, what is Dental Insurance Network?
A dental insurance network consists of a list of practices that have a contract with an insurance company. For instance, if a patient is covered under an HMO or DHMO insurance plan, they can only make use of their benefits stated at in-network practices. This option tends to be inconvenient and rigid and such plans are often disliked by many as such plans prevent patients from visiting an of their choice or one they trust and are comfortable getting treated by.
On the other hand, patients covered under PPO plans, are free to visit any dentist of their choice. Depending on the plan the patient is covered under and the plan’s network, the patient can expect to save on the price of their treatment. However, there certainly are some coverage differences between the in-network and out-of-network practices.
For dental practices, be in-network with insurance companies means they are entering into a contractual agreement with them. This makes the practice a “participating provider.” This contract defines the patients who come into your practice, your claims reimbursement process, and the rate of your fees.
For instance, a patient can only visit your dental practice only if they are covered by the insurance your practice is in-network with, to receive discounts on the services availed. Let us look at the benefits of being a practice in-network with insurance companies.
Pros of being an in-network practice
Dental practices often choose to be in-network with insurance because it provides them with more access to patients. Patients, on the other hand, prefer going to in-network dentists over out-of-network dentists because of the affordability factor and the ease of finding a dental practice that would accept their insurance.
Here are the advantages of being an in-network practice:
- Marketing and advertising opportunities:
Practices that are in-network with insurance are promoted free of cost by the insurance company. Thus the patients are easily able to find your practice in their insurance portal. This is a great opportunity for small practices that are trying to expand their patient base.
- Access to more patients:
The ease in accessibility in addition to being promoted free of cost by the insurance company the practice is in-network with ensures that the practice receives plenty of patients. This ensures a full schedule for the practice and constant revenue generation. If a practice seeks to increase in quantity, being in-network is the best choice for them.
Cons of being an in-network practice
In all honesty, insurance companies are not really allies to practices especially when it comes to paying the practice. Once a practice signs a contractual agreement with a dental insurance company the practice is bound by the terms and conditions of the insurance company. When insurance has more input in how a practice is run and what patients it accepts, it may not always be in the best interest of the dental practice.
Here are the disadvantages of being an in-network practice:
- Pre-established fees with the insurance company:
When an insurance company enters goes in-network with a dental practice, the practice has to agree on the fee schedule for its service, as established by the insurance company. Negotiating these fees can be quite difficult and can be a drawback for dentists who want to charge more for their services.
- Less time spent on patients:
Sometimes quantity can take away from quality. When a practice has back-to-back patients, it is quite natural for the dentist or a front desk team member to feel pressed for time. This often leads a decrease in the quality of care provided to patients.
As the term suggests, the out-of-network practice are those that are not in any kind of contractual agreement with insurance companies. The practice still does accept insurance, but they can also charge the full fee to their patients. These practices also have the liberty of deciding the type of care they provide to patients without the input of the insurance company. There are plenty of benefits to being out-of-network as a dentist.
Pros of being an out-of-network practice
One of the biggest advantages of being an out-of-network practice is that the practice retains control over every aspect of the practice. The insurance company does not have any opinions over any aspects of the practice or its patients. The practice still has to process insurance claims but not at the same rate as in-network dentists do.
Here are the advantages of being an out-of-network practice:
- Flexibility in rates determination:
Controlling your own fees is a really liberating feeling for dentists. Being able to decide what your services are worth is a huge benefit to being out-of-network. This is especially appealing if the practice offer specialty services that aren’t widely available in that area.
- Easier revenue collection:
A lot of dentists find it very difficult to collect their revenue after administering treatment. Hence, becoming a fee-for-service dental practice is the most ideal option for them. This becomes possible if the practice is out-of-network and can seamlessly transition to this kind of a billing model. In this model the practice collects the full fee from the patient after their procedure after which a claim is sent out on their behalf. The patient then gets reimbursed their insurance.
Cons of being an out-of-network practice
Being out-of-network can turn out to be a little overwhelming for some dental teams because there is an evident dilemma on where to start on their pricing. This also makes the practice harder for patients to find and reach out to, and oftentimes even too expensive for some patients.
Here are the disadvantages of being an out-of-network practice:
- Decreased accessibility for some patients:
If a practice aims at being more affordable and accessible to patients, then being out-of-network is not exactly the best choice for the practice. The practice can definitely choose to fix the price as low as they wish to but realistically speaking, that option is not very feasible especially if the practice chooses to be heavily equipped infrastructure-wise. The practice would also be required to spend a considerable amount of time marketing itself if it wishes to grow its patient base.
More time spent on patient billing:
Since the fees at out-of-network dental practices are higher in comparison to in-network practices, collecting the right amount from patients can get difficult. This results in having dental teams sit down with the patients to explain their benefits to them and why they are priced the way they are. In order to carry this out successfully, practice is required to have a streamlined patient billing process. This is a time-consuming process and the dental teams will end up spending more time fulfilling lesser important tasks.