What is an out of network dentist?

When you are in a Dental HMO or a Dental PPO, there is a network of approved dentists. The list is usually available on your company's website; many times searchable by zip code for the nearest to your location. In a Dental HMO you have to go to a dentist on the list for services to be covered. In a Dental PPO, you can go to a dentist that is not on the list. A dentist not on the list is "out-of-network." When you go to an "out-of-network" dentist the costs that you pay yourself will be higher for two reasons. The Dental PPO has arranged discounts with dentists on the list, i.e. in the network, so the percentage you pay is of a lower or discounted amount. The out-of-network dentist can charge their full fee. Second, the percentage covered is less. Typically for prevention--like an office visit and cleanings--the DPPO pays 100%, but they may only pay 80% of . For basic procedures like fillings--the DPPO pays 80%; but only 60% of the "out-of-network" dentist's fee. Evelyn F. Ireland, CAE; Executive Director National Association of Dental Plans