Preferred Provider

Many dental insurance plans have created lists of "preferred providers." Others call them "in-network dentists." The concept is the same.

Some of these plans offer two levels of "in-network" dentist plans for different amounts of money. Let me explain them so that you know what you're getting.

The fundamental principle you need to understand about these dental plans is where the interests of the company lie. They exist to make money for their stockholders. Your interest, however, is in your own pocketbook and the dental health of your family. It some cases, your interests are at odds with the company.

This foundation is essential to understanding what they mean by the term "preferred provider." To be "preferred" by the dental insurance company, the provider needs to save them money. That is the foundation of the whole system. When they solicit dentists to participate in their dental plan, they will usually present a list of conditions that the dentist needs to meet and a fee schedule that they need to charge. Different dental insurance plans are more or less restrictive. The most economical ones will place more severe restrictions on the dentist. For example, a dentist may have a usual fee of $900 for a crown, but the company says that they can only charge $700 to their patients. So the dentist tries to figure out if he or she can charge this fee. Maybe the dentist can use a cheaper lab or less expensive materials, or do it a little faster, or maybe just accept less profit.

For you, the decision about whether to use an in-network dentist or an out-of-network dentist should be a simple matter of economics. Is the out-of-network dentist worth the extra money you will pay for their services? Don't impart some moral superiority to the term "preferred provider" as used by your dental insurance company. Out-of-network dentists will tend to be fussier about their work, will spend more time on procedures, use more expensive materials, and may run offices that give lots of personal attention and even pamper the patient. To you, if that's worth the extra that you're paying, then do it. But if you need to save money on your dental care, you may want the cost-cutting in-network dentist.