What You Should Know About Out of Network Costs and Dental Insurance Surprises

In Uncategorized by premiersmiles1 Comment

According to an analysis in the New York Times, the Affordable Care Act (ACA) has brought with it a new era of complex health insurance products that demand higher premiums, narrower provider networks and higher deductibles. The policies under the ACA wants the consumer to bear more financial risk so that he/she is more cautious and careful about healthcare spending. However, the reality is quite different. People are struggling with surprise bills from healthcare providers, paying hefty amounts to out-of-network care providers or just avoiding healthcare services altogether.

Emergency rooms and Urgent Care Centers present another insurance nightmare for people. After being treated in an Emergency room patients often receive huge bills from their insurance companies. The number one reason for higher than expected bills include being treated by a doctor at the facility who was not employed by the hospital. A New England Journal of Medicine study on a large national insurer found that 22 percent of the time patients who went to an Emergency Room (in the hospital they were covered for) still received a bill from a doctor who was not in the insurance company’s network. Texas was amongst one of the states that had a very high rate of surprise bills (89% to be precise).

Out of Network Healthcare Explained

Hospitals and insurance companies often blame doctors for being behind the high surprise bills. Many doctors working in the hospitals do not agree to be on the same plan, with insurance providers, as the hospital they work at. Due to this, after treating patients doctors bill insurance providers and they negotiate their own deals. In many cases, the insurance company pays part of the doctor’s fee and the patient pays the remaining part. If they do not come to an agreement about the payment, the patient gets a higher bill for out-of-network service than usual.

A recent New York Times/CBS poll found that 46 percent of Americans said they had trouble affording health care. Many think of dental insurance of being an unnecessary expense and often avoid getting it till they end up in an emergency. Many insurance providers do not explain the fine print and details like Emergency room surprise bills (especially in dental cases) to consumers when selling their insurance plans. Due to this lack of awareness people paying high premiums assume that their healthcare is covered, at least in their specific network. Therefore, it is highly recommended that when you buy a dental health insurance plan you talk to your insurance provider and the dental clinic about emergency and urgent care scenarios and try to figure out what would be the most economical option in case you need to rush to the ER.

Dental health might seem expensive and not an important part of your health but it can affect your overall health considerably. A toothache or bleeding gums can be the cause of many underlying health problems that can only be diagnosed by a dental health practitioner. Premier Smiles believes in offering the best dental health services and helping its clients choose customized and affordable plans so that they can maintain a beautiful smile at all times. Set up a meeting with our dental health experts or call our assistance team today to learn more about affordable, hassle-free dental care.


  1. Smile is a very valuable thing to everybody yet is priceless. I would like to say thanks to premierdallasdentist for having this blog. Keep posting for more!

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