April 2021
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Why to Visit a Non-Participating Dental Insurance Office

Insurance providers often only prescribe the bare minimum. So if you want to get the best for your money, you may want to visit a dentist who will tell you what really needs to be done to your teeth and not only what the insurance companies will provide. Dr. Bart Kreiner is the owner of the dental practice, Dr. Kreiner Family Dentistry, in Bel Air, Maryland. He gives his opinion here about why it can make sense to visit a non-participating dental insurance office.

In general, the insurance companies set the fees that a participating provider can charge. They do that based on what they think is clinically acceptable. But I don’t think insurance companies always know what is actually clinically accepted, or what is best for the patient’s individual needs.

Let me take an example. An insurance company will only pay for two professional dental cleanings a year. This is acceptable for patients who do not have any gum disease; however, more than 75% of people have some form of gum disease. If they only do what the insurance pays for, they can still end up losing teeth.

Many patients with their own insurance plan come to my dental office, though I am not registered as a participating provider. They prefer to pay their deductible and copay, and the difference between what I charge and what the insurance company pays. That is an out-of-pocket expense, so it could potentially be more expensive for them to see me than to go to a participating dentist.

But I believe that in this way, the patients are getting best value for their money, and taking care of their teeth in the best way possible, even if they have to pay more themselves. In the long term, the advantage is obvious – they will keep their teeth in good condition.

So it’s important for patients to be offered all treatment choices, including doing nothing. Once they know all risks and benefits, they will decide what is best for them. It should not be a case of the insurance company saying, “Well, this is all we are going to pay for.”

Welcome to my dental office for a consultation, whether you are insured or uninsured.

The information in the article is not intended to substitute for the medical expertise and advice of your healthcare provider. We encourage you to discuss any decisions about treatment or care with an appropriate healthcare provider.

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