Whether you need dental insurance or vision insurance , it’s important to determine the level of coverage that you’ll receive when you use an in-network provider versus an out-of-network provider. You might be surprised to discover that choosing the wrong provider can make your out-of-pocket expenses much higher. 

Not sure what in-network vs. out-of-network means? Don’t worry, we’ve got you covered. Check out the FAQs below to learn more. 

The difference between in-network and out-of-network

What does it mean to be in-network with insurance, and what does out-of-network insurance mean?  

Dental and vision insurance companies have networks of providers that have entered into contracts with them. Some plans come with large networks, while others have smaller networks of dentists and eye doctors that you can choose from. 

Does in-network mean lower out-of-pocket costs?

Yes! 

By sticking with dentists and eye doctors that are in-network, you can save more money, as well as take full advantage of the benefits that a plan provides. 

How does this work? Well, these professionals are willing to accept discounted rates for their services in exchange for being a part of the network. Also, the insurance company will cover more of the cost when you visit an in-network provider. All of this means that your out-of-pocket costs will be more affordable.

How do you know if a provider is in-network?   

If you have a specific dentist or eye care professional that you want to continue using, it’s wise to select an insurance plan that they work with. 

Insurers usually make it easy to figure out if the provider of your choice is in-network. For example, you might just need to perform a simple search on their website. 

What is out-of-network insurance?

Out-of-network providers haven’t entered into the same types of agreements as those who are in-network. Therefore, your out-of-pocket costs, such as your copay, coinsurance, and deductible, will likely be higher. 

Note: Some insurance policies will have a separate deductible for out-of-network providers, and it is typically higher than the in-network deductible. 

Will insurance cover out-of-network providers at all? 

The answer to this question depends on the type of plan you sign up for.

• You can find plans that provide out-of-network insurance coverage. In that case, if you use an out-of-network dentist or eye doctor, you may still receive some level of support from your insurance provider. However, as mentioned above, you should be prepared to pay more out of pocket than you would with in-network insurance because your share of the costs will be higher.
• There are plans that don’t provide any coverage whatsoever for providers that are out of network. This means you’d have to pay the full amount on your own.
• Some plans will only help cover the costs of emergency care that you receive out of network. 

How do I get reimbursed for an out-of-network provider? 

There are insurance policies that will let you see a provider that is out of network, and then reimburse you to help pay for the cost. The amount that you’ll be reimbursed will depend on the plan’s details. 

If you’re enrolled in a plan that provides you with a reimbursement when you see an out-of-network dentist or eye doctor, your insurer will instruct you on how to go about receiving it. Typically, you’ll need to submit receipts to prove the amount that you paid.