Choosing an in network or out of network dentist in Scottsdale changes more than which chair you sit in, it changes your bill. In-network dentists have negotiated rates with your dental insurance, while out-of-network providers set their own fees, often meaning higher out-of-pocket costs even with coverage. Knowing the difference protects your budget before booking any Dental Services.
By Lernor Family Dental Team, Scottsdale Dentists
Understanding whether you have an in network or out of network dentist in Scottsdale starts with a simple contract. When a dentist is in-network, the practice has agreed to a negotiated fee for each procedure, usually lower than its standard rate, and your insurance pays a set percentage while you cover the rest. An out-of-network dentist has no such contract and sets its own fees based on its costs and the local market.
This matters because dental insurance plans are built around these networks. Most plans, including PPOs, still provide some benefit for out-of-network care, but the reimbursement math works differently, and the gap between what your insurer pays and what you owe can widen quickly. HMO-style plans are usually stricter, often providing no benefit outside the network.
How an Out-of-Network Dentist Changes What You Pay in Scottsdale
Seeing an out-of-network dentist in Scottsdale does not mean your insurance disappears, but it does shift more cost onto you. Instead of a negotiated rate, you are billed at whatever the dentist charges, and your plan reimburses based on its own fee schedule rather than the dentist's actual price.
Do Out-of-Network Dentists Charge More for the Same Procedures?
Not necessarily. Many out-of-network dentists charge close to what in-network dentists charge for routine dental care like cleanings, fillings, and exams. The bigger cost driver is not the sticker price, it is how much of that price your insurance actually pays. An in-network dentist's negotiated rate is the ceiling your insurer reimburses against, while an out-of-network rate is not tied to that ceiling, so an identical fee can leave you owing more. Complex Restorative Dentistry work tends to show the widest gap, simply because the dollar amounts are larger.
The Real Cost Difference Between In-Network and Out-of-Network Dental Care
The real difference rarely shows up in the price of the visit, it shows up in the reimbursement percentage and the deductible. In-network dental care usually applies your plan's full benefit against a rate your insurer already agreed to. Out-of-network dental care often applies a lower reimbursement percentage, a separate deductible, and a UCR-based cap on the allowed amount. Two patients getting the exact same filling can walk away with different bills once those factors compound, which is why understanding your plan's out-of-network benefit is the real starting point for budgeting dental care in Scottsdale.
Can You Still Use Dental Insurance at an Out-of-Network Dentist?
Yes, in most cases you can still use dental insurance at an out-of-network dentist. Your plan does not stop paying just because your dentist has no contract with the insurer, but how the payment reaches you and how much it covers looks different.
How Out-of-Network Reimbursement Works
Out-of-network reimbursement is typically based on a percentage of what your insurance company considers a usual, customary, and reasonable fee for that procedure, not necessarily what your dentist charged. You may pay the dentist directly at the time of service, then submit a claim for reimbursement, or the practice may submit it for you. Either way, the check often goes to you rather than the dentist, and the reimbursed amount is capped at your plan's allowed amount even if the actual bill was higher. The remainder, sometimes called balance billing, is your responsibility.
Will Your Insurance Deny an Out-of-Network Claim?
Usually not, as long as the procedure is a covered benefit under your plan. Denials are more commonly tied to missing documentation, an excluded procedure, or benefits already maxed out for the year, rather than the dentist's network status alone. That said, some plans, particularly HMO-style plans, provide zero out-of-network benefit by design, which functions like an automatic denial for any claim from a provider outside the network.
Can an Out-of-Network Dentist Still File My Insurance Claim for Me?
Many out-of-network practices will file the claim on your behalf as a courtesy, even without a network contract. It is worth asking directly, since policies vary by office. Some practices ask patients to pay in full at the time of service and handle the paperwork separately, since without a network agreement they have no direct payment relationship with your insurer. Either way, you typically still need to provide your insurance information up front.
What's a UCR Fee and How Does It Affect My Bill?
A UCR fee, usual, customary, and reasonable, is the amount your insurance company determines is typical for a procedure in your area, based on data it collects from providers. Your out-of-network reimbursement is calculated against this UCR amount, not against what your dentist billed. If your dentist's fee is higher than the UCR amount your plan recognizes, you are responsible for the difference on top of your normal coinsurance.
How to Find Out If a Scottsdale Dentist Is In-Network With Your Plan
The most reliable source is your insurance company itself, not the dentist's website. Log into your insurer's member portal or call the number on your card and ask for a current list of in-network providers near you. Provider directories can lag behind reality, since dentists join and leave networks throughout the year, so a quick call to the dental office confirming their network status is worth the extra few minutes. That confirmation is the real answer to whether you are looking at an in network or out of network dentist in Scottsdale for your specific plan. When you search, include your plan type, since a dentist can be in-network with one plan from an insurer and out-of-network with another plan from that same company. Searching by your home or office address also helps: a handful of in-network dentists within a few miles usually beats driving across Scottsdale, AZ for a marginal savings difference.
Is It Worth Switching Dentists Just to Stay In-Network?
Sometimes, but not automatically. If you need extensive dental care soon, like multiple restorations or ongoing periodontal treatment, the savings from staying in-network can add up fast enough to justify the switch. If you only need routine cleanings and exams, the cost difference may be small enough that continuity of care with a dentist you trust is worth more. Switching also has a cost of its own: new patient paperwork, a fresh set of x-rays if records do not transfer cleanly, and the time it takes to build a relationship with a new provider.
Does Lernor Family Dental Accept Your Dental Insurance?
Coverage and network status change year to year as insurance companies update their contracts, so the most accurate answer for your specific plan comes from a quick call to our Scottsdale office. Patients often ask whether we are in-network with Delta Dental or another major carrier, and because plans within the same insurance company can differ, we verify benefits individually rather than quoting a blanket answer. Even when we are out-of-network with a particular plan, we can typically still file the claim on your behalf and walk you through what your reimbursement is likely to look like before you commit to treatment. We welcome new patients and are happy to check your dental insurance details before your first visit.
Frequently Asked Questions
Does having dental insurance guarantee lower costs at any dentist?
No. Dental insurance guarantees a benefit, but how much it covers depends heavily on whether your dentist is in-network. At an in-network dentist, your plan pays against a negotiated rate. At an out-of-network dentist, it pays against a UCR amount that may be lower than the actual fee, so the same insurance can produce very different out-of-pocket costs.
Is it cheaper to see an in-network dentist for a simple cleaning?
Usually yes, though the gap is often small for routine dental care like cleanings and exams. In-network visits typically apply your full preventive benefit with little to no cost to you, while out-of-network cleanings may involve a deductible or coinsurance that an in-network visit would not.
Can I ask a dentist to match my insurance's in-network rate?
You can ask, but a dentist is not obligated to match a rate they never agreed to in a network contract. Some practices offer their own in-house discount or payment plan for patients without in-network coverage, worth asking about directly.
Do dental insurance plans change their networks during the year?
Yes. Providers join and leave networks, and insurance companies update their contracted fee schedules periodically, sometimes mid-year. A dentist who was in-network last year is not guaranteed to still be in-network today, so confirming status before a major treatment plan is worth the call.
What should I bring to a first appointment if I am unsure about my network status?
Bring your current insurance card and, if you have it, a recent explanation of benefits from your insurer. Our team can verify your dental insurance details and network status before treatment begins, so you know what to expect on your bill as a new patient.
Get Clarity on Your Dental Insurance Before You Book
A quick call to our Scottsdale office can confirm whether you are working with an in network or out of network dentist in Scottsdale before you commit to treatment. Book Appointment with Lernor Family Dental and we will verify your dental insurance details ahead of your visit.