Participating Vs. Non-Participating Dental Insurance Providers

So, what is the difference between a participating and a non-participating dentist with an insurance company??

A participating provider chooses to enter into a contractual agreement, agreeing to accept the benefits that the insurance company is willing to pay for a particular procedure, as payment in full.

A non-participating provider does not enter into a contractual agreement; and, therefore, is not bound by the limits of what a particular insurance company is “willing” to pay for a procedure.

Here’s a way to look at this insurance scenario:

A participating dentist is working “FOR” the insurance company, as he or she is being governed by them as to what he or she will receive as payment.  Keep in mind that participating dentists need to see a volume of patients to close the monetary gap that the insurance company leaves open.  In most cases, the quality of care can be affected due to the fact that they have to see more patients to cover their overhead.  Procedures may be recommended which are more costly.  Treatment can be guided by covered procedures and fee schedules rather than by chosen treatment plan by patient and dentist.

A non-participating dentist is working for YOU, the patient.  He or she is not willing to accept the much lower payments for their procedures, and is not willing to sacrifice the quality of care in order to see a volume of patients.  By not participating, decisions regarding your treatment are made between you and your dentist based upon YOUR dental needs and YOUR desires rather than the plan restrictions of the insurance policy.

Of course, the insurance companies encourage you to see participating providers, as they keep more money in their pockets.  This is a common practice with insurance companies.
The bottom line is; choose a provider that you trust, feel comfortable with, and provides you with quality care.  After all, YOU are the patient and YOU do have a choice. Although many patients do not have any dental insurance, many of those who do have dental insurance, have chosen our practice for all of these reasons.