Navigating Benefits

What to Do When a Popular In-Network Dentist Moves Out of Network

  • If a favorite dentist leaves your company's dental plan, notify fellow employees immediately

  • Workers can keep going to the dentist, but it will likely cost them more money

  • They can find a new dentist in their area or look into dental savings plans to help cut the costs of seeing an out-of-network dentist

Posted by July 23, 2018

The availability of an in-network dentist can be one of the most important parts of a good dental plan. However, changes often occur, and it’s possible that a dentist you and your coworkers like will someday leave the network.

So, what can you do when a preferred dental provider moves out of your company’s network? Here are some tips for helping team members move forward when their favorite dentist leaves.

Strategies for Notifying Employees

You don’t want fellow staff members to be caught off-guard when their dentist is no longer in-network. So, it’s best to have a plan in place for notifying the workforce of any changes in provider status.

First, it’s always a good idea to provide a list of in-network dentists to all employees. Send out the list in an email or provide a link to a website with the information. A 2017 study found that 54 percent of employees would like their organization to provide a list of in-network dentists.

Once you’ve done this, you should also let team members know every time there’s a change in provider status. This can be done with a simple alert notification sent by email whenever the list of in-network dentists changes. Many dental plans will notify your company when provider statuses change, which makes your job of notifying employees pretty simple. Ask your health care agent if your dental plan provides this feature.

Keep in Mind: Out-of-Network Dentists Cost More

Seeing an out-of-network dentist will always cost more, but exactly how much depends on whether your dental plan is a DPPO or a DHMO. DHMOs, which have lower premiums, typically only cover your visit if you go to an in-network dentist. So, if you’re on a DHMO, the out-of-network visit won’t be covered at all and workers will have to cover the entire price themselves.

In contrast, DPPOs typically provide some level of reimbursement for out-of-network dentists, but they will still cost more. Since DPPOs also come with yearly maximums, there’s also a chance that going to an out-of-network dentist might cause your coworkers to hit that maximum faster.

Your health care agent should be ready to meet with affected employees one-on-one and explain exactly how their prices will change if they keep seeing the dentist in question.

So, What Are Employees’ Options?

Your team members have multiple options if their preferred dentist leaves the network. Here are a few actions they can take:

  • Keep the plan and keep seeing the dentist. If individuals choose this option, their prices will likely be higher, as described in the section above. If they have a DPPO, they might also need to start filing their reimbursement claims themselves.
  • Switch to a new dentist. This is probably the easiest solution. If your organization is already providing a list of in-network dentists, then it should be simple for employees to find a new dentist near to where they live or work.
  • Switch to a new dental plan that covers their dentist. Sometimes this is an option. But if workers do this, they might face a waiting period before pre-existing conditions are covered, depending on how the new plan works.
  • Join a dental savings plan to help defray some of the costs. In some situations, your coworkers might be able to join a dental savings plan to help cut down on the out-of-network costs.

As you can see, there are quite a few options available when an in-network dentist leaves your company’s dental plan. Remember, it’s always a good idea to offer affected employees the chance to meet one-on-one with HR or a health care agent to discuss their options.

It can be a little tricky when in-network dentists leave your plan, but with a few strategies and policies in place, you can make the transition easier—and less confusing for employees. That’s making the best of an uncertain situation.

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