Pike Lake Dental is going out-of-network

FREQUENTLY ASKED QUESTIONS

• What does this mean?
  • The office is no longer in network with your insurance company. 
  • You will be using your out-of-network benefits instead. 
  • Many dental insurance companies keep the same or similar coverage for in- and out-of-network providers. *Some dental policies will require you to see an in-network dentist.

• Can I still stay at Pike Lake Dental?
  • YES! This doesn’t necessarily mean you need to find a new dentist. We are happy to continue seeing you and your family, and hope you will remain a patient at Pike Lake Dental! 
  • We can still take and accept your dental insurance. We currently see patients with insurance that is out of network, and have for many years. 
  • Once this is in effect, you might receive a letter from your insurance company providing you with a list of in-network dentists, but this may not mean that you have to see an in-network dentist. Many insurance policies allow you to see a dentist that is out of network. There are a few exceptions. *Some dental policies will require you to see an in-network dentist. 
  • Call your dental insurance company to find out if your dental policy requires you to see a dentist in their network. 
  • Dental Benefits Breakdown Worksheet 

• Are you out of network with my insurance?
  • In 2024, Pike Lake Dental will be out of network with all insurances EXCEPT: United Concordia (military), VA, & Delta Dental.
  • In 2025, Pike Lake Dental will be out of network with all insurances.
  • Insurance companies and employer examples we will be out-of-network with in January, 2024.
  • Insurance companies and employer examples we will be out-of-network with in January, 2025.

• Why aren’t you taking my insurance?
  • We can still take your insurance. Going out of network allows the office to be free from contractually obligated (fine print) restrictions, clauses, and contracted fee allowances. 
  • When a dental office chooses to participate with a network, in return for new patients they accept the company’s contract, policies, and their lower fee schedules.
  • This has become a one-sided relationship since our office has had to put a hold on scheduling new patients.

• How much will my visits cost?
  • The cost of your services will be dependent on your specific dental insurance policy. You will have some additional out-of-pocket expenses with your dental visits. We are hopeful that it will not be a significant difference overall. You may notice your care might have a higher out-of-pocket cost.
  • Why?
    • This is because many insurance companies use a Usual, Customary and Reasonable fee schedule (UCR). UCR is an amount set by each insurance company, but it is not standardized. The UCR will vary between insurance companies and their policies.

                    For Example: 

• • • Your dental hygiene appointments might still be covered at 100%, but 100% of the UCR fee.

• • As our office works with more out-of-network dental insurance companies, we will be able to provide more information specific to your policy.
  • For policy specific questions, you will need to call your dental insurance company, and a customer service representative can answer questions specific to your dental policy. Before calling, print the Dental Benefits Breakdown Worksheet.

• Do I need to bill my insurance if it’s out of network?
  • No. As a courtesy to you, we will still submit claims to your insurance company on your behalf. We will no longer be contracted to do the “insurance adjustment,” but everything else about the process will be very similar. 
  • Your insurance company may pay directly to you, but that is policy specific. Many insurance policies still send payments to the dental office following the “Assignment of Benefits.”

• How do I know what my policy allows?
  • You can call your dental insurance customer service, and use the dental benefit breakdown worksheet found on the website for guidance. Usually the customer service phone number is listed on the back of your insurance card.
  • Once you have your Dental Benefits Breakdown Worksheet completed, please email a copy to pikelakedental@gmail.com and a member of our team can assist you with any additional questions.

• What if I already have treatment planned for next year?
  • If you have any questions about your current proposed dental treatment, please ask a member of our treatment coordinator team to send an estimate to your dental insurance! 
  • Starting January 2024, we will be able to do a pre-treatment estimate with your out-of-network benefits. 

If you have additional questions, please give our office a call! We want to talk you through this process and help ease your worries about this change. Our office phone number is (218) 729-7270.