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The Difference Between In and Out of Network

Commonly Asked Dental Insurance Questions

Here at Affiliated Dentists we accept almost all dental insurance plans.  However, many people get confused by all the different types and insurance plan coverages.  The most common questions we are asked about dental insurance are below.  If you don’t see your question here, feel free to contact us by clicking here for more information.

“Does Affiliated Dentists accept my dental insurance?”

We are providers for almost all insurance companies.  However, it is highly recommended you call the insurance or your HR department before making your first appointment. (If you’ve already done that, you can request an appointment online.)  Your dental insurance rep will help you find out what area dental clinics accept your specific plan.  As you signed up for and pay for the insurance, you are responsible for knowing where you can and cannot get coverage.

Click here for a list of all the insurances our offices accept.  Please note this list shows all accepted insurances, both in and out of network.

“What is the difference between in network and out of network?”

In Network Provider

Affiliated Dentists is an in network provider for many insurances.  This means we have signed a contract with those specific insurance companies saying we agree to charge you a lower contracted rate than our standard office fees.  Another benefit of seeing in network providers is even if your insurance doesn’t cover a certain procedure at all (i.e. crowns, implants, etc) we will still submit it to your insurance company so you still get a discounted rate off your out of pocket portion.

Out of Network Dentist

An out of network dentist is not contracted with certain dental insurances meaning insurance pays less or nothing at all to the dentist for any procedures. This means you may be left with a much larger out of pocket portion for work done at an out of network dental office.

“How do I know if your office is in or out of network with my dental insurance?”

The best and quickest way to figure this out is to call your insurance company (or your HR department if you don’t know what your insurance is).  Ask them to tell you what dental clinics in your area are in network with your specific plan.  You might have Delta Dental Insurance which our office accepts, but as there are literally thousands of different plans just under Delta Dental of Wisconsin alone, our staff cannot know your specific coverage.  When you call your insurance company, they will not only be able to tell you which offices are in network, but they can also tell you an entire breakdown of your benefits, what your yearly maximum is, if you have an annual deductible and more.

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“What work will be covered by my insurance at your clinic?”

As stated in the previous question, the quickest way to find out how much your insurance covers annually is to call them.  Your insurance also sends you a packet of your Explanation of Benefits once you are signed up for your dental insurance plan.

Once you have become an established patient at Affiliated Dentists, our staff can send a preauthorization of any treatment that has been diagnosed to your dental insurance.  This will give you a better idea of what they will cover.  This is highly recommended for treatment such as fillings, crowns, implants or periodontal cleanings.

“Will my medical insurance cover any dental work at your clinic?”

There are very few health plans out there that cover dental work, but they do exist.  When you sign up for your medical insurance initially, it should say in your Explanation of Benefits informational packet sent to you whether or not any dental work is covered.  Very few medical plans will cover dental work, and most of the time it’s only when caused by some sort of accident. The only way to know is if you check your Explanation of Benefits packet or call your medical insurance and ask.  If you DO have dental coverage under your medical insurance, be sure to let our front office staff know right away so it can be entered into our system.

“But wait, why don’t you put my medical insurance on file anyway?”

Because dental coverage is so extremely rare on medical insurance plans, our staff will not ask for your medical insurance card.  If you know you have dental coverage on your medical insurance, it is your responsibility to let us know (but make sure that dental coverage is accepted at our office first by calling your medical insurance company and asking!).

If you are diagnosed for an appliance to help you with TMJ or teeth grinding, it might be covered by your medical insurance and not your dental insurance.  If this is diagnosed for you, our staff will then ask you for your medical insurance information.

My insurance says it is PPO. What does PPO stand for and what does it mean?

PPO stands for Preferred Provider Organization. This type of insurance normally requires you to visit doctors within a certain network in order to receive insurance coverage.  To find what dentists you can go to, call the customer service number for your dental insurance company.

Is there a discount for out of pocket payers who do not have dental insurance?

Yes.  For those who do not have dental insurance, we offer a 5% discount on all services.  We do require payment day of treatment.

Insurances We Accept at Affiliated Dentists Madison:

  • AETNA PPO
  • AETNA DENTAL ACCESS
  • AMERITAS
  • AMERICAN DENTAL PROFESSIONAL
  • ASSURANT
  • ANTHEM (BLUE CROSS BLUESHIELD)
  • DEAN
  • DELTA DENTAL PPO AND PREMIER
  • DENTAL CARE ADVANTAGE (With copayments due day of service.)
  • DENTAL HEALTH ALLIANCE (DHA)
  • DENTAL WELLNESS PARTNERS
  • CIGNA
  • CONNECTICUT DENTAL
  • CONNECTION DENTAL
  • FORTIS
  • GEHA
  • GROUP HEALTH
  • GUARDIAN
  • HUMANA
  • HUMANA ACCESS
  • METLIFE
  • PREMIER
  • PRINCIPAL
  • TRICARE (METLIFE)
  • USA DENTAL (With copayments due day of service.)
  • UNITED HEALTHCARE (UHC)
  • UNITED CONCORDIA
  • WEA

Sorry, these are Insurances We Do Not Accept at Affiliated Dentists Madison

  • MEDICAL ASSISTANCE
  • FORWARD
  • BADGER CARE
  • MEDICAID
  • PHYSICANS PLUS
  • UNITY
  • MOMENTUM

If you have any questions, please contact the insurance customer service line on the back of your insurance card. If you do not have insurance, please call our offices and we can answer questions related to your first visit. Schedule an appointment online today.

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