Dentist referred me to a provider who is outside my network. What are my options (if there are any)? Will I just need to pay more than what I would have paid if they were in-network?

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If they’re out of network then your insurance will just cover less than if they were in network (the total amount you pay depends on the price - like if the out of network is cheaper overall you could pay the same or less out of pocket). As far as options, you could ask what the price is for cash/no insurance (sometimes this is cheaper). Or you can find another provider within network (you can call your insurance or look up online if you need their help finding a specific type of treatment or specialist). You can also try to get your insurance to honor an out of network doctor by doing some paperwork. Either submitting a super bill or sometimes a letter explaining why this doctor/procedure was necessary even if they’re out of network.

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It will probably cost you much more. There’s two elements, first you don’t get the negotiated price, so the provider can charge you anything they want to charge. Second, out of network has its own deductible so even if you met your deductible, expect to pay out of pocket unless you have met the deductible for out of network. And then the insurance typically pays a lower percentage for out of network. Maybe only 60-70%. But I agree with PWC1 that you can negotiate. We got a referral for a procedure that was out of network for one of our kids and we called and asked and they agreed to accept a payment of $1500 for the procedure. Your alternative is to ask the dentist if they have other recommendations or just find another provider that’s in network.

I would go back to the dentist and ask for a referral IN your network.

You have that right to do so.

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