What will benefit your practice most: In-Network VS Out-of-Network Insurance

Many practices are unsure of the pros and cons of being in-network vs out-of-network. Which has the higher cost? Accommodating in-network rates or chasing patients for their payment? It all depends on what your practice needs.


As a dental provider, being in-network means you must negotiate with insurance companies and accept their rates. Patients are responsible for paying the difference between the provider’s full charge and the plan’s approved amount. Generally, patients pay less with in-network providers, but providers may also be paid less per visit.
On the other hand, patients often seek out dentists that take their insurances, so getting patients will be easier. Insurances provide better customer service for enrolled providers, they might not feel obligated to provide any information if you are out-of-network.


Practices that are out-of-network (OON) don’t accept the insurance fee schedule and are either fee-for-service or receive the patient’s OON payment benefits, they can also charge any balance as patient responsibility. Many insurance companies will send the service payment to the patient. This means the practice must either collect the money beforehand and hope that the insurance pays the patient in a timely manner, if at all, or they must rely on the patient to pay them after they have received their insurance money. Furthermore, because out-of-network claims are more costly to the insurances, if a provider wants to follow-up on an unpaid claim, insurance companies may not be helpful and sometimes will not even provide an EOB to the practice. Patients can end up frustrated; they feel OON providers are not transparent about their fees, or they may not get their insurance payment in the mail and put the blame on the dental clinic.
For providers with great online presence, going OON can make a lot of sense. Patients may be willing to fork out their own money if they feel they will be getting quality care. However, dentists must really consider that without good reviews or web presence, it is already hard to get patients in the door, and for OON dentists, it will be even more of a challenge.

Synapse offers credentialing and website services to all our clients.  In the end, whether your practice is in- or out-of-network with some or all insurances is up to you. Synapse offers credentialing and website services to all our clients to help them in their decision.

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