Dental Benefits
How do dental networks work?
What in-network and out-of-network rules can mean for your employees.
Denta team · · 1 min read
A dental network is a group of dentists with a contract under a plan. That contract can affect the allowed fee and what an employee pays. Network rules differ by plan type, so check the exact policy rather than relying on the label alone.
What changes in network
A PPO typically has contracted dentists who agree to a plan's allowable fees. Outside the network, a dentist may charge more than the plan allows, leaving a larger patient balance. Some plans pay little or nothing outside their network. The ADA outlines PPO, DHMO, EPO, and other dental plan types.
Three checks before enrollment
- Search the plan's current directory for dentists employees already use.
- Call the dental office and confirm participation in the specific plan, not just the carrier.
- Compare the estimated employee bill for the same procedure inside and outside the network.
An explanation of benefits can show the allowed amount, plan payment, and patient share after a claim. The ADA explains those fields and why out-of-network balances can differ.
If network access is your team's top concern, make it an explicit line in your startup dental insurance comparison.