What’s the difference between in-network and out-of-network dental?
"Out-of-network" sounds scary, but it rarely means "no coverage." Here’s what it actually changes for you.
The short answer
An in-network dentist has signed a contract with your insurance plan agreeing to set fees for that plan’s members. An out-of-network dentist hasn’t signed that particular contract — but that does not mean your insurance won’t help. Many plans still pay out-of-network benefits; they just pay them differently, and a little more of the cost may be left to you.
Highmark Dental files claims with most major insurers as a courtesy so your benefits are applied — but we are not part of managed-care or HMO networks, and we’ll never tell you otherwise. What you’d owe depends on your specific plan, which is why we verify your benefits and explain them before treatment.
What actually changes when a dentist is out-of-network
- Your plan may pay a smaller share of the fee, leaving a bit more to you
- The plan may base its payment on its own fee schedule rather than the dentist’s
- You may pay at the visit and be reimbursed, or the office may file for you (we file as a courtesy)
- Some plans — especially strict DMO/HMO plans — only pay when you see an assigned in-network provider; we’ll tell you plainly if yours is one of those
How to know what it means for your plan
The honest answer is that "out-of-network" plays out very differently from plan to plan. Some PPO plans pay nearly the same either way; others leave more to you. Only your policy can say for sure.
For anything larger than a routine visit, the surest way to know is a pre-treatment estimate: we submit the proposed treatment to your insurer and they reply in writing with what they’ll cover — before any work is done.
If you’d rather just talk it through in plain English, our free Benefits Coach can help you understand your plan and the exact questions to ask, and the office can verify your specific benefits for you.
Questions worth asking your insurer
- "Does my plan include out-of-network benefits for dental?"
- "How does the plan pay for an out-of-network dentist — and how much is left to me?"
- "Is there a deductible or waiting period before those benefits apply?"
- "Will you accept a pre-treatment estimate so I know before I decide?"
How we can help
If any of this sounds like what you’re dealing with, the fastest way to real peace of mind is a quick exam. We’ll tell you exactly what’s going on and lay out your options — and the fees — clearly before we start anything. We accept many dental insurance plans and file your claims as a courtesy; see our Insurance page for the plans we accept. We keep time open for same and next-day emergencies when you need us.
Frequently asked questions
Is Highmark Dental in-network with my insurance?
We are not part of managed-care or HMO networks, and we don’t claim to be. We file claims with most major insurers as a courtesy so your benefits are applied, and we tell you before treatment what your plan is likely to cover. If your plan requires an assigned in-network provider, we’ll say so upfront.
Does out-of-network mean my insurance won’t pay?
Usually not. Many plans still provide out-of-network benefits — they simply pay differently, and a little more of the cost may fall to you. The exception is strict DMO/HMO plans that only pay for an assigned provider. Your insurer can confirm which kind you have.
How can I find out exactly what I’ll owe?
For larger treatment, ask for a pre-treatment estimate. We submit the plan to your insurer and they respond in writing with what they’ll cover before any work happens — the closest thing to a guarantee that exists. We’re glad to set that up.
Keep reading
Still not sure? We’re glad to help.
A quick call or visit beats guessing. Dr. Skiba will give you a straight answer and a clear plan — with no pressure.