In-Network vs. Out-of-Network Dentists: What's the Difference (and What It Means for Your Costs)

Choosing between an in-network and out-of-network dentist can have a big impact on what you pay, how your claims are handled and how far your dental benefits go. Understanding the difference between in-network and out-of-network dentists can help you avoid unexpected costs and make the most of your Delta Dental plan.

What Does “In-Network” Mean?

An in-network dentist is a provider who has a contract with Delta Dental. That contract means the dentist agrees to applicable fee allowances for covered services, which can help lower your out-of-pocket costs. The in-network dentist can not bill you for the difference between the applicable fee allowance and their full billed charge for covered services. Additionally, the in-network dentist should not bill you up front for covered services except for any applicable coinsurance, copayments and deductibles that you may owe.

For members, seeing an in-network dentist often means a simpler, more predictable experience. In-network dentists file claims for you, and their contracted fees help limit what you pay for covered services. That can make it easier to budget for your dental care needs.

Choosing an in-network dentist can also give you added confidence that your benefits are being used as efficiently as possible. Delta Dental offers access to one of the largest dental networks in the country, making it easier to find care that fits your dental plan.

What Does “Out-of-Network” Mean?

An out-of-network dentist is a provider who does not have a contract with Delta Dental. Because there is no agreement in place, that dentist has not agreed to Delta Dental’s contracted fee allowances.

You can still choose to see an out-of-network dentist in many cases, but the cost structure is often different. You will need to check your plan to ensure it includes coverage when seeing an out-of-network dentist. Out-of-network dentists may charge higher fees, and your plan’s payment may be based on the applicable fee allowance rather than the dentist’s full billed charge. The out-of-network dentist can bill you the difference between the applicable fee allowance and their full billed charge. Depending on your plan and the dentist, you may also be required to pay for the services upfront or handle more of the claims process yourself, such as submitting the claim to Delta Dental for processing.

That is why it is important to check a dentist’s network status before your appointment — especially if keeping your out-of-pocket costs down is a top priority.

Difference Between In-Network and Out-of-Network Dentists (At a Glance)

Feature	In-Network Dentist	Out-of-Network Dentist
Contracted fees	Yes. The dentist agrees to contracted fee allowances with Delta Dental.	No. The dentist sets their own fees and can collect the full amount.
Who files the claim	The dental office files the claim for you.	It depends on the dentist. In some cases, you may need to submit the claim to Delta Dental for processing.
Balance billing risk	No, because contracted fees apply. You are typically not responsible for the difference between the billed charge and the applicable fee allowance for covered services.	Yes, because the dentist may charge more than the plan's allowed amount. You may be responsible for the difference between the billed charge and the applicable fee allowance.
Out-of-pocket cost predictability	Usually more predictable.	Often less predictable.
Plan coverage percentage	May provide stronger cost savings depending on your plan and network.	Coverage may still apply, but your share of the cost is often higher.
Upfront payment required	Less likely in many cases, depending on the office. You may only be billed up front for any applicable coinsurance, copayments and deductibles.	More likely, especially if the dentist does not submit claims on your behalf. You may also be responsible for the services up front.

Out-of-Network Dental Costs: What You Might Actually Pay

Out-of-network dental costs are often higher for a few key reasons. It is important that you know and understand your dental plan design.

First, out-of-network dentists are not bound by contracted fee allowances. That means the amount they charge for a service may be higher than what an in-network dentist would charge for the same treatment.

Second, you may be responsible for balance billing. This is the difference between the applicable fee allowances for a service and what the dentist actually charges. If your dentist’s fee is higher than the fee allowance, you may have to pay that difference out of pocket.

Third, depending on your plan, out-of-network care may have a different deductible or coinsurance amount, or may not offer any dental benefit coverage if you see an out-of-network dentist. Even when your plan helps cover the service, your share of the cost may still be higher.

Finally, higher fees may result in meeting your annual benefit maximum more quickly. In other words, out-of-network care may reduce the overall value you get from your dental benefits.

Compare options with our Dental Plan Comparison.

How Delta Dental Networks Work

Delta Dental gives members access to multiple network options, and the network your dentist participates in can affect how much you pay.

Delta Dental PPO^TM providers typically offer the deepest discounts. If your dentist participates in the PPO network, you will usually see the greatest savings on covered services.

Delta Dental Premier® providers are also in the Delta Dental family of networks, but savings may not be as deep as they are with PPO providers. Premier can offer broader access while still helping members reduce costs compared to out-of-network care.

Out-of-network providers do not participate in Delta Dental’s contracted networks, so there is no contracted fee allowance discount. As a result, your out-of-pocket expenses may be higher.

When using Delta Dental’s provider search tool, be sure to check which network a dentist participates in. That detail can make a meaningful difference in what you pay.

Can I Still See an Out-of-Network Dentist With My Delta Dental Plan?

Yes — in many cases, you can still see an out-of-network dentist with your Delta Dental plan. But there are trade-offs.

Out-of-network care may mean:

Higher out-of-pocket costs
Less predictable pricing
Potential balance billing
More paperwork or claim filing responsibility

There are situations where seeing an out-of-network dentist may still make sense. You may already have a long-standing relationship with a dentist you trust. You may need a specialist who is not in your network. Or you may need care quickly in an emergency situation.

The most important step you can take is to verify network status before you receive care. A quick check ahead of time can help you better understand your costs and avoid surprises later.

How to Find an In-Network Dentist

Finding an in-network dentist is one of the easiest ways to make the most of your dental benefits. Here’s how to do it:

Visit the Find a Provider tool.
Select your Delta Dental plan or network.
Enter your ZIP code or location.
Review the list of dentists near you.
Call the dental office before booking to confirm they still participate in your network.

Dentist network participation can change, so it is always a good idea to confirm network status directly with the office before your appointment.

Choosing the Right Plan for the Dentist You Want to See

If you are shopping for dental coverage and already have a preferred dentist, start by checking which Delta Dental network(s) that dentist participates in. That can help you choose a plan that works well with the dentist you want to keep seeing.

Delta Dental of Iowa offers plan options designed for different needs, including Preventive Prime, Preferred Prime and Platinum Prime. The right fit depends on your budget, the type of dental care you expect to need and whether your preferred dentist participates in the network tied to your plan.

If keeping access to a specific dentist is important to you, checking the dentist’s network participation before enrolling can help you make a more informed decision.