What "Out-of-Network" Means (And Why It Actually Works in Your Favor)
If you have dental insurance, you have probably heard the phrase “out-of-network” before and assumed it was a bad thing. The name alone makes it sound like a limitation, like you are missing out on something or paying more than you should. The truth is more nuanced than that, and for patients who want truly personalized, unhurried dental care, being treated by an out-of-network dentist may actually stretch your dollar further than you think.
At Travis J. Calhoun, DDS, we are a fee-for-service practice, meaning we are not contracted with any insurance companies. What that means for you as a patient is that we file your insurance on your behalf, and your carrier reimburses you directly for covered services. We have been serving western North Carolina for over 30 years, and our approach has always centered on what is best for the patient, not what is dictated by an insurance contract. You can learn more about how we handle payments and financing to make care as accessible as possible.
How Does Out-of-Network Dental Care Actually Work?
A lot of patients walk in thinking that out-of-network means their insurance simply will not help. For most PPO plans, that is not the case. The American Dental Association outlines several types of dental benefit plans, and many PPO plans still provide reimbursement when you see a non-contracted provider. The amount varies by plan, but the benefit does not disappear just because your dentist is not on a preferred list.
Here is how it typically works: you pay for your visit at the time of service, we submit the claim to your insurance company on your behalf, and your carrier sends you a check or direct deposit for your covered portion. Whether the reimbursement goes to you or to our office depends on your specific plan, but either way, you are not simply throwing your insurance away by choosing us. If you have questions about what to expect as a new patient, our new patients page walks through what to bring and what to anticipate at your first visit.
Why In-Network Dentists Sometimes Have to Say No
When a dentist signs a contract with an insurance company to become an in-network provider, they agree to a set fee schedule. That sounds straightforward, but what it often means in practice is that the dentist is working within constraints that may not align with what you need. Insurance companies decide which materials are covered, which procedures they will pay for, and at what reimbursement rate. If the recommended treatment falls outside those parameters, you may hear something like, “Your insurance does not cover that.”
Out-of-network practices operate differently. Our recommendations are based on your clinical needs, your preferences, and what we genuinely believe is in your best interest. Our dental services cover a wide range of restorative and preventive care, and we make those decisions at the chair, not in a carrier’s billing department.
Your Care Is Not Limited by a Network’s Priorities
In-network arrangements also affect things patients rarely see, like the time allotted per appointment, the materials used for restorations, and which specialists a dentist may refer you to. Fee-for-service dentistry removes those guardrails. Appointments here are built around you, not around how many patients need to be seen to offset a lower reimbursement rate.
What You Get When You Choose Fee-for-Service Care
Here is a straightforward look at what patients often notice when they transition to a fee-for-service practice:
- More time in the chair: Appointments are scheduled to accommodate thorough care, not to hit a production target tied to contracted rates.
- Material choices driven by quality: When we recommend a particular restoration, the decision is based on durability and fit for your mouth, not on what an insurance plan will reimburse.
- A direct relationship: You are our patient. The treatment plan we present is built around your health goals, full stop.
- Transparency upfront: We discuss costs before treatment so there are no surprises, and we file your insurance so you still get any reimbursement you are owed.
Choosing fee-for-service care does not mean walking away from your insurance. It means working with a practice that puts your needs first while still helping you make the most of your benefits. For patients who want flexible options beyond insurance, we also offer financing options to help make treatment more manageable.
Does Going Out-of-Network Cost More?
This is the question we hear most often, and the honest answer is: it depends on your plan. Some PPO plans reimburse at nearly the same rate for out-of-network providers as they do for in-network ones. Others apply a higher coinsurance or deductible for out-of-network visits. The best step is to call the member services number on the back of your insurance card and ask your carrier two things: does my plan include out-of-network benefits, and what percentage does it cover for a non-participating dentist?
Many patients are surprised to find their reimbursement is reasonable and that the difference in out-of-pocket cost is worth it for the level of care they receive. We are always happy to walk through your insurance paperwork with you so nothing catches you off guard.
Schedule an Appointment with Travis J. Calhoun, DDS in Asheville, NC
Dr. Travis Calhoun has been caring for Asheville families for over 30 years. He earned his dental degree from the University of North Carolina at Chapel Hill and returns year after year to continuing education to keep his skills sharp. His mission, in his own words, is to treat every patient like they were his mom, providing the best care available in an atmosphere where patients feel relaxed and comfortable. You can read more about his background and philosophy on our meet Dr. Travis page.
If you have been putting off care because you are not sure how out-of-network insurance works, we want to make it simple. Our team files your insurance, answers your questions, and works hard to make sure you understand what to expect before any treatment begins. Reach out through our contact form and let us know how we can help.