Why is my dentist Out of Network

Have you ever wondered why your favorite dentist is out of network with your dental insurance plan? Dental insurance can be a complex and often confusing topic, leaving patients scratching their heads when they discover their go-to dental professional is outside their insurance network. This can present a challenge when it comes to accessing the care you need while staying within your budget. In this blog post, we’ll explore the reasons behind your dentist’s out-of-network status, the impact on your insurance coverage, and tips for navigating this often-misunderstood aspect of dental care. So, let’s dive in and unravel why your dentist may opt-out and become an out-of-network dental provider.

Why do dentists drop out of provider networks?

Numerous factors contribute to why some dental offices decide to be outside-network with various dental plans. Here are some common reasons why a dentist may opt-out as an out-of-network provider.

  • When selecting a dentist, your decision regarding who should deliver dental care should not be constrained by your employer or insurance provider’s preference for the lowest cost.
  • Reimbursement rates offered by the network are lower than the cost of treatment. Participating in a provider network can involve accepting discounted fees in exchange for a patient base, but as time goes on, some dentists may decide that the reimbursement rates offered are too low to be able to provide the best possible care.
  • You and your dentist should collaboratively choose your dental treatment. Insurance companies primarily focus on profit, which may lead them to recommend treatment options that do not prioritize the patient’s best interests or desires.
  • Dentists may leave provider networks due to disagreement over treatment options. Some networks may have restrictions on the types of procedures or materials that dentists are allowed to use, which can be frustrating for dentists who want to provide the best possible care for their patients. In some cases, dentists may feel that the restrictions imposed by the network are compromising their ability to provide high-quality care.
  • The dental staff dramatically impacts the quality of care and service provided to patients. Exceptional, well-educated, skilled, dedicated, and compassionate team merit competitive compensation and benefits. Practices attempting to function at reduced reimbursement rates often pay their staff less, resulting in higher staff turnover, which will, in turn directly affect the patient experience.
  • Insurance premiums consistently rise yearly, but the annual coverage limits remain unchanged. In numerous instances, the annual coverage limit is identical to what it was a decade ago or even lower. As insurance companies amass increasing revenue, the value of the patient’s benefits continually diminishes.
  • Dental insurance carrier may initially promise to cover a dental procedure, only to later deny the patient’s claim. Additionally, they may cover the same procedure for different patients under the same plan at varying rates. This inconsistency makes it nearly impossible for dental offices to accurately inform patients about expected out-of-pocket costs, resulting in the office appearing erroneous despite their genuine efforts to provide reliable information.
  • Finally, some dentists may leave provider networks due to administrative or bureaucratic issues. Working with a network can involve a lot of paperwork and bureaucracy, which can be time-consuming and frustrating for dentists who would instead focus on patient care.


If your current dentist is an out-of-network provider, you can still see them if you have out-of-network dental benefits, but you may be responsible for a larger portion of the bill or a higher copay. The type of insurance you have will determine how much is covered and the dollar amount you’ll ultimately be responsible for.

To determine whether your dentist is an in-network or out-of-network provider, you can check your dental insurance plan’s provider directory or contact your dental insurance company directly. In-network dentists have signed a contract with the insurance company to charge established rates for specific dental services, while out-of-network dentists do not have such a contract and may charge higher fees. Additionally, many dentists’ websites include information on the insurance plans they accept, which can help you determine if they are in-network or out-of-network providers.

Summed up, It isn’t an easy decision for the dentist or the patient, but sometimes there are circumstances beyond the dentist’s control lead to the change. Understanding why your dentist may be out-of-network and the options available can help you make informed decisions about your dental care. Always prioritize your oral health and choose a dentist you trust, whether in or out-of-network. Keep smiling!

Happy Family Smiling