Putting Your Care First
Dental insurance contracts can place limitations on fees, procedures, materials, treatment frequency, and other aspects of care. By remaining out-of-network, our doctors have the freedom to recommend treatment based on what they believe is best for your health.
This allows us to:
- Use high-quality materials and advanced dental technology.
- Spend the appropriate amount of time with each patient.
- Create personalized treatment plans based on your individual needs.
- Keep clinical decisions between you and your dentist.
- Maintain the standard of care our patients have come to expect.
It also gives you more freedom. Instead of choosing a dental office solely because it appears on an insurance company's provider list, you can choose the dentist and dental home where you feel most comfortable.
Yes, You Can Still Use Your Dental Insurance Here
One of the biggest misconceptions about out-of-network dentistry is that you cannot use your insurance benefits. With most PPO dental plans, you can.
Many PPO plans include both in-network and out-of-network benefits. Depending on your specific plan, the difference in your out-of-pocket cost may be smaller than you expect.
Our team helps make the process as simple and transparent as possible. We will:
- Submit insurance claims on your behalf.
- Review your treatment plan and estimated insurance benefits with you.
- Clearly explain your estimated out-of-pocket cost before treatment.
- Provide pre-treatment estimates to your insurance company upon request.
Because every plan is different, we encourage patients to look beyond whether a provider is simply listed as "in-network" and instead understand how their specific plan pays for out-of-network care.
Please note: Some dental plans, including many HMO and state-funded plans such as Medicaid, may not provide benefits when you receive care from an out-of-network provider.
Understanding Your Dental Insurance
Dental insurance works differently from medical insurance.
Medical insurance typically includes an out-of-pocket maximum, which limits how much you may have to spend during the year. Dental insurance generally works in the opposite direction by providing an annual maximum benefit—the maximum amount your insurance company will contribute toward your dental care during the benefit year.
Many dental plans have annual maximums around $1,000–$1,500. Once your plan's maximum has been reached, your insurance company generally stops contributing toward additional covered treatment until your benefits renew.
This is one reason we encourage patients to think of dental insurance as a benefit that helps offset the cost of care, rather than something that determines which treatment they should receive.
Seeing "100% covered" on your dental benefits can be confusing because it does not always mean there will be no cost to you.
Insurance companies may calculate benefits using their own allowed fee, rather than the dentist's actual fee.
For example, if our fee for a procedure is $100 but your insurance company considers $50 to be its allowed amount, a plan that pays "100%" may pay 100% of $50, not $100.
At an in-network office, the dentist has agreed by contract to accept the insurance company's fee and may be required to write off the difference. An out-of-network dentist is not bound by that contracted fee, so the patient may be responsible for the remaining balance.
That is why "100% covered" does not always mean "$0 out of pocket."
Our team will review your estimated benefits and financial responsibility with you whenever possible so you have a clearer idea of what to expect before treatment.
If you have questions about your specific dental insurance plan or how your out-of-network benefits work, we recommend contacting your insurance carrier directly. Because every plan is different, your insurance company is the best resource for the most accurate and up-to-date information regarding your coverage and benefits.
Dental practices across the country are reevaluating their relationships with insurance companies as the cost of providing high-quality dental care continues to increase.
Staffing, dental materials, laboratory fees, equipment, technology, and other costs have changed significantly over time, while many insurance reimbursement rates and annual benefit maximums have not kept pace.
For an in-network practice, significantly reduced contracted fees can eventually require difficult compromises—such as seeing more patients in less time, reducing expenses, limiting technology, or changing how care is delivered.
Those aren't compromises we are willing to make.
We want our doctors and team to have the time, materials, technology, and clinical freedom necessary to provide the level of dentistry our patients expect from Palm Valley Family Dentistry.
Not necessarily.
Your actual out-of-pocket cost depends on the details of your specific dental plan—not simply whether a provider is labeled "in-network" or "out-of-network."
Some PPO plans offer excellent out-of-network benefits, while others reduce reimbursement significantly. Depending on your plan and the treatment you need, there may be very little difference in cost, while other plans may result in a larger difference.
That's why transparency is so important to us.
Our team will help you understand your benefits, provide estimates when possible, and explain your expected financial responsibility so you can make an informed decision about your care.
Your Insurance Should Support Your Care, Not Dictate It
Dental insurance can be a valuable tool to help offset the cost of your care, and we encourage our patients to use the benefits available to them.
However, your insurance company ultimately determines what it will cover, how often it will cover it, and how much it will contribute. Those decisions are based on the terms of the plan selected by you or your employer—not necessarily on what your dentist determines is best for your oral health.
An insurance denial does not mean treatment is unnecessary, just as insurance coverage does not automatically mean a procedure is the best treatment for every patient.
We believe insurance should help pay for your care—not determine your care.
Why We Believe It's Worth It
Our decision to remain out-of-network comes down to protecting the quality of care we provide.
We want to spend the appropriate amount of time with you, use high-quality materials and advanced technology, recommend treatment based on your individual needs, and continue providing the personalized care our patients have come to expect.
We will continue working with most PPO dental insurance plans, submitting claims on your behalf, helping you understand your benefits, and providing clear estimates whenever possible.
Your insurance company may help pay for your dentistry. Your dentist should decide how that dentistry is provided.