How Does Dental Insurance Work?

Dental insurance is a very different type of insurance than health or auto insurance. Dental insurance really is just a maintenance plan that will cover some treatments up to a maximum amount per year. This yearly max is typically between $1000 - $2000 USD.

There are restrictions and rules to being able to qualify for the insurances to pay even after they’ve promised they will. Here is a breakdown to help you better understand dental insurance plans.

In-Network vs Out-of-Network

In-Network means that a dentist has signed a contract with them to take that insurance plan.

For example if it costs a dentist $250 to provide a high-quality, no problem filling, your insurance will pay them less than $100 for it because they signed this contract. Thus, your filling it not the same quality as the $250 filling.

Most dentists are In-Network with insurance companies. This means that they have signed a contract with your insurance company to accept a lower fee for the treatment that you need. The insurance company gets to pay the dentist less money than their normal/standard fee.

The trade is:

  • The insurance company sends the dentist patients by marketing and referring patients to this dentist.

  • The dentist takes less money for the same service. They in return provide a less expensive service. So they may use a less expensive lab, a less expensive tooth filling, a less expensive crown or implant.

Less expensive generally means less quality.

Lambert & Co. is not willing to sacrifice quality when it comes to treating our patients so we do not like this model.

Out-Of-Network

Out-Of-Network means that a dentist has not signed a contract to take a below average fee for the treatment that you may need from them.

For example if it costs $250 to provide a high quality no problem filling, your insurance will pay $250 for your filling. We have not agreed to accept below average fees.

Few dentists are Out-of-Network because it can be difficult to explain insurance plan differences to clients. In reality, most insurance plans have Out-of-Network benefits.

PPO Plans will pay Out-Of-Network doctors. So, if you have a PPO Dental Insurance plan, you can see an Out-Of-Network Dentist. This means that your dentist can send a bill to your insurance company, and your insurance will pay the dentist the rate the dentist needs, to give you the treatment you need.

Insurance companies prefer their clients do not go to Out-of Network Doctors because it costs them more money, and their goal is to pay out the least amount of money over the year as possible. If they pay less, they have more money to keep, based on a business model of making money from premiums.

How We Can Help

Our mission is to provide you the highest-quality service and treatment, no matter what insurance plan you have.  

  • We agree to help you get the treatment that you need.

  • We agree to not accept below average fees for the treatment you need.

  • Our goal is to make everything as crystal clear as your smile.

If you are looking to find out more, let us know which insurance plan you have, and our team will:

  • Call and verify if your insurance will pay us or pay you, or not pay at all.

  • We bill your insurance for you at no charge.

  • We allow your insurance to pay us directly.

  • We only bill you the portion your issuance does not pay, such as deductibles and copays.

To understand how to get the most from your coverage, contact our Dental Insurance Plans Expert, Anne-Marie on
+1 866 234 6139.

Anne-Marie is based out of our Tribeca Dental Practice, and will be happy to take a look at your plan, and let you know how it measures up. Alternatively, feel free to shoot us an email at info@lamberttribeca.com and we’ll call you back!

Lambert Co