"Dentist In Partnership With An Insurance Provider": What It Means And What It Means For Your Billing And Oral Care

23 May 2016
 Categories: Dentist, Blog


When your current dentist cannot perform a specific dental service, you may be referred to another professional that can help. If this happens to you, you may be wondering if this other dentist is covered by your health insurance plan. You may see "dentist in partnership with an insurance provider" on your dental records, but what does that mean? Will you be billed for the full cost of the care or treatment you receive from this new dentist? Here is a better explanation of what that means so that you can feel a little less anxious about billing and be more focused on your appointment.

The Phrase, "Dentist in Partnership..." Can Mean Two Things

When you see "dentist in partnership with an insurance provider" it usually means one of two things. One, the dentist does not typically take a particular insurance but has agreed to be paid with this insurance provider's funds for cases that have been referred to him or her from another healthcare system. Two, the dentist has a more formal and flexible agreement to take a provider's insurance, but it is not the main insurance brands or types that the dentist usually takes. If you have been referred to another dentist that is out-of-provider and part of another healthcare system because your own dentist cannot perform the procedures needed, then you are covered under the first unusual circumstance. You may also be covered under the second circumstance if the dentist is willing and able to bill your insurance provider for the treatment or procedures that he or she provides.

What It Means for Your Billing and Oral Care

You may have somewhat larger co-pays depending on how your insurance operates under these unusual situations. However, most of the typical dental charges are billed to your insurance, regardless of which of the two special circumstances mentioned above that you fall under. You may not return to the second dentist, however, unless you receive continued referrals for care from the dentist you originally saw (the in-network dentist). Since that is rather unlikely, you can continue to see your old dentist as your follow-up care requires and he or she will be able to bill your insurance provider for these visits and follow-up treatments as needed. Of course, if you need any additional special services for which your regular dentist cannot provide, then you may see the second dentist again, but your billing and oral care remain relatively unaffected.

For more information, contact a dentist like Northwest Dental Services and Implant Center.