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What to Do When You Use an Out-of-Network Dentist Accidentally

Updated: Aug 18, 2023

Accidentally using an out-of-network dentist is an expensive hassle. You thought your dentist is in-network, benefits were verified and you received an estimate from your dental clinic of projected out of pocket. But then, you receive an unexpected dental bill in the mail or electronically.

The teeth removal or whatever dental care you had a couple of weeks ago wasn’t covered by your insurer. It turns out your dentist is now out-of-network and maybe even your clinic. Now, you’re required to pay an outrageous balance bill you can’t afford.

Well, you’re not alone. This scenario happens more often than you think. And fortunately, the situation can be resolved. Read this post to the end to find out what to do when you accidentally use an out-of-network dentist.

First, Why is Your Dentist Suddenly Out-of-Network?

This question is the first thing that would come to mind when you get a surprise dental bill. Here are two main reasons your previously in-network dentist is now out-of-network.

1. It Might be an Error

Yes, your dentist may not be out-of-network after all. An error might have occurred when your dentist filed the claim with your insurer. Thus, resulting in a wrong balance bill.

For instance, if there is a coding mistake or the service level is different than what was estimated. Say you had your teeth polished, but it was mistakenly coded that you had braces done. You’ll be sent a surprise balance bill if your insurer doesn’t cover braces in that dental clinic.

Tip: Review your balance bill to ensure there’s no error in the list of services you received. And check your insurer’s explanation of benefit (EOB) to confirm your coverage.

2. The Dentist’s Contract Expired

Dentists are in-network when they sign a contract with an insurance company. The insurer brings them patients, while they agree to charge a subsidized fee for their services.

Your previously in-network dentist can suddenly be out of network if their contract with the insurance company has expired. Perhaps they couldn’t agree on mutually beneficial terms or the renewal contract deadline was overlooked.

Tip: Always double-check to see if your dentist is still on your insurer’s in-network lists before receiving dental services. Dentists often forget to update patients on their network status.

How to Resolve Out-Of-Network Dentist Bill Issues

When you mistakenly use an out-of-network dentist, there’s hardly anything your insurance company can do about it (except if there was an error). However, you can speak to your dentist to resolve the dental bill issue.

  • Request a waiver for disallowed charges. Disallowed charges are the extra charges on top of what your insurance is willing to pay. Say your insurance pays a max of $1,000 for teeth polishing, but the dentist asks for $1,500. The extra $500 is the disallowed charge. You can ask your dentist to write off the disallowed charge. Since you’ve been an in-network patient with the dentist, they should be willing to waive the extra charge.

  • Negotiate your dental bill issue. If your dentist isn’t willing to waive the disallowed charges, try negotiating. You can agree on the percentage of the balance you can pay conveniently. Or negotiate a plan to pay the balance bill over a period. Another tip is to negotiate a prompt pay discount if you can pay the balance in full in a single payment.

  • Get billed as an in-network patient. Lastly, your dentist can continue to bill you like an in-network patient. That is, they will bill you the same amount they would if you were in-network. So, your dentist would get paid by your insurer, and you won’t be balance billed.

Why Would Your Dentist Agree to These Resolutions?

You're probably wondering why your dentist would agree to waive disallowed charges, negotiate your balance or bill you as an in-network patient.

Well, businesses, including dental clinics, don’t like losing customers. And, you’ll likely leave their practice to use an in-network dentist if the issue isn’t resolved or if you've had less than satisfactory customer service in the past. So, your dentist would do whatever it takes to ensure you keep patronizing their clinic for your dental care.

Reasons Out-of-Network Dentist Bills Are Outrageous

If it’s possible to resolve an out-of-network dentist bill by paying a lower negotiated balance, why are the bills so outrageous in the first place? Here are two reasons you receive a huge balance bill when you use an out-of-network dentist.

  • More expensive charges. Out-of-network dentists’ costs are more expensive because they are free to charge whatever they want for their services. Unlike in-network dentists, who may charge a more reasonable cost negotiated with their insurance companies. For instance, an insurer may negotiate $600 for a tooth removal with an in-network dentist. And the same dentist can charge an out-of-network patient double or more.

  • Lower insurance coverage. Preferred Provider Organization (PPO) insurance plans cover services received from both in-network and out-of-network dentists. But, the plan covers less percentage of the dental cost at out-of-network clinics. For instance, your insurance plan may cover 80% to 100% of the cost of your dental care received at an in-network dentist, and less than 50% at an out-of-network dentist. Some plans also have a deductible, even on routine prevention care, that must be met first before benefits are paid.

Resolve Out-of-Network Dental Bills With Your Dentist

Accidentally using an out-of-network dentist can lead to an unexpected dental bill. But, it doesn’t have to result in bad debt that affects your financials. You can resolve the bill by discussing the situation with your provider.

And remember, just because you’ve been using the same dentist forever and they’ve always been in-network doesn’t mean things can’t change. So, always verify that your dentist AND clinic is still in-network before receiving dental care.

Need more help with resolving dental bill issues? Contact your area's local patient advocate or reach out to MBCR today!

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