Can I Use My Insurance For My Out Of Network Oral Surgery?

Do you need oral surgery? If so, you may be wondering whether or not your insurance will cover the procedure. As healthcare costs rise, employers are picking and choosing what insurance plans they provide for employees.  Dental insurance can feel like less of a benefit as more and more dental services are excluded from your coverage. When compared to health insurance, dental insurance is significantly less comprehensive, which can be frustrating for patients who need procedures that are not covered. Dental benefit plans specifically exclude coverage for many needs.   

Most dental and medical benefit companies offer some level of coverage for oral surgery procedures, but your specialty care will typically require an investment beyond what your insurance will cover.  Your benefits will assist you with some of the costs, but they were never designed by its creators to cover all that you need. Unfortunately, a dental benefit company’s willingness or unwillingness to cover an oral surgery service has no relation to medical necessity.

Doctors have shared this burden with patients. Throughout the industry more and more doctors have been turning to out-of-network models in order to meet inflationary economic demands and to remain current with the ever evolving standards of care their patients deserve. So what if your oral surgeon is out of network for your insurance provider? Can you still use your insurance and choose your own surgeon?

The answer is Yes!

Here’s is some insight about in versus out-of-network providers:

What Does “In-Network” Mean in Insurance? 

When an oral surgeon is in-network with your insurance provider, it means that the cost of services has been pre-determined by the insurance company. This contractual arrangement has some very tangible benefits for patients because there are policies that do offer benefits for common elective and semi-elective services that may include oral surgery procedures and anesthesia. However, these plans often provide only limited benefits with a low dollar limit per year, and at a much lower percentage of the actual overhead cost of providing that care.  The policy specifics are determined  by third parties (the employer and dental benefit company) void of any input from, or involvement with, the doctor providing the care, or the patient receiving it.  Coverage generally comes with a maximum dollar limit of $1000-$2000 for the year, in addition to frequency limitations on the number of visits and procedures allowed during a set period of time. Many do not realize that these maximum dollar limits allowed for patient care have not increased in almost 30 years!

For patients who are covered under an in-network insurance plan, there are definitely pros and cons to consider. But ultimately, it is important to acknowledge that no two doctors have the same background, skill set, training, or experience. No two oral surgery practices necessarily offer the same level of customer service and care.  Moreover, many elective, in-office oral surgery procedures, are not necessarily considered covered benefits anyway, regardless of the doctor’s in-network or out-of-network status. These are just a few of the reasons we believe one should never choose an oral and maxillofacial surgeon based solely on a third party insurance company’s recommendation. There are just too many contributing factors involved in the fine print of this equation and choosing the right surgeon requires careful consideration of many points.

We believe that trusting a surgeon with your care is a sacred and profoundly personal decision and that having surgery is an extremely vulnerable time for a patient. We believe you deserve the doctor of your choice. Fortunately, contrary to commonly held misconceptions about dental insurance, many patients are able to use their dental insurance for care with the doctor of their choice, even if their chosen doctor is out-of-network.

What Does “Out of Network” Mean in Insurance? 

When a doctor is out-of-network, this does not mean the practice “does not take your insurance.” An out-of-network oral surgeon is a doctor who is not bound to a contractual financial agreement with your insurance provider.  However, most out- of-network or “non-contracted” providers like Dr. Lucca remain professionally credentialed with third party insurers, and can still bill your insurance company for the standard costs of the services you receive.  Unlike at in-network practices, there are not different prices set for patients with dental benefits and for those without. Out of pocket payers, therefore, do not subsidize the reduced fees contracted for insurance payers and this balances the cost of care at our practice making it more equitable.

Most dental insurance companies are open networks with out-of-network benefits available for their subscribers. Coverage may come as a lump sum toward a specific procedure or as a percentage of the overall cost. Some plans actually pay the same (or in some cases even better) benefit amounts for out-of-network services as they do for the very same in-network services.  We encourage patients to investigate the specifics of their plans.  

Lucca Oral & Facial Surgery Will Work With Your Insurance Plan

If you need oral surgery and you’re not sure where to go, Lucca Oral & Facial Surgery successfully assists many hundreds of patients per year coordinating claims with most major insurance providers and dental benefit plans that need to be processed out-of-network. We make the process easy and frictionless. We electronically bill your dental insurance provider on your behalf for the cost of services, and we provide any follow up necessary in order to maximize the benefits you are entitled to receive in the fastest way possible.  We are committed to providing you with state-of-the-art treatment and helping you use the benefits allowed to you by your insurance provider for care in our office. 

Dr. Lucca is a board certified oral and maxillofacial surgeon with over 20 years of experience. Lucca Oral and Facial Surgery is committed to maintaining the integrity of the doctor patient relationship and we have established a reputation for excellence in the community providing advanced care and a first class experience. We are devoted to our patients and value the confidence and trust our referring doctors allow us to earn each time they choose us to be a partner in patient care.

To learn more about our office, call 617-300-0345 or contact us today to schedule an appointment.