A Dental Referral Mistake Could Cost You
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A Dental Referral Mistake Could Cost You

12 Nov, 2015

A Dental Referral Mistake Could Cost You

I went to the dentist a while back and, after my exam and cleaning, he recommended that I see a specialist regarding an issue with my gums.
When he brought me the a name of a periodontist, I asked if this referral was an in-network provider on my dental insurance plan. He looked stunned. As if no one had ever asked this question.
He went to check. When he came back he brought a different name.
It turned out that the original name he was going to give me was not in my insurance network and would have cost me more than I needed to pay.
The dentists in your plan's network have agreed to pre-negotiated discounted rates for their services. If the specialist you are referred to is not in that network, he can charge whatever he wants. Your dental insurance is not going to pay anything more than a fraction of the usual and customary rate for the procedure. This would leave you paying much more for out-of -network services than you would be paying in-network.
This is a common mistake that many people make when being referred to a specialist by their family dentist. They assume that their doctor is paying any attention to your network.
The truth is that your dentist has other things on her mind and your insurance network isn't one of them. If your dentist had to pay this specialist she would be more concerned, but she doesn't. You do!
It may be that your family dentist gets referrals from the specialist they are suggesting and are returning the favor as a courtesy to the other doctor. Maybe this is their cousin, their brother in law or golf buddy. Maybe they are looking to earn brownie points socially. Even worse, they may have some ownership interest in the other practice and will make more money by sending you out of your network. None of these is a good reason for you to spend more of your hard earned money than you need to.
So, don't assume your dentist or doctor cares more about your money than you do. And don't be intimidated or embarrassed. My dentist looked embarrassed, as he should have been for making a recommendation that would have me wasting my money.

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James Archer is a writer, webmaster and an insurance agent in Florida.

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