In-Network vs. Out-of-Network Dental Billing: What’s the Difference?

When it comes to dental insurance, one of the most common sources of confusion—for both patients and dental teams—is the difference between in-network and out-of-network billing. Understanding how each one works is essential for proper claim submission, accurate patient estimates, and smooth collections.

Whether your practice is contracted with insurance plans or operating fully out-of-network, here’s a clear breakdown of what each billing type means—and how it impacts your revenue and patient experience.

1. What Does “In-Network” Mean?

When a dental provider is in-network with an insurance company, it means they have signed a contract with that insurance carrier. This contract:

• Establishes set fees (also called “allowed amounts”) for services

• Often requires writing off the difference between your full fee and the allowed amount

• Means the provider agrees to submit claims directly to the insurance company

• Typically results in lower out-of-pocket costs for patients

Being in-network can attract patients who want to maximize their insurance benefits, but it also comes with tighter restrictions on fees and billing policies.

2. What Does “Out-of-Network” Mean?

A provider who is out-of-network does not have a contract with the patient’s insurance company. This gives the dental office more flexibility in setting their own fees and policies. In this case:

• The insurance may still pay for services, but often at a lower rate

• The practice can bill the patient for the difference between the insurance reimbursement and the office’s full fee

• Some plans require patients to submit their own claims (though many offices still do this as a courtesy)

• Patients may pay more out of pocket

Out-of-network billing offers more control for the provider, but it requires clear communication with patients about costs and coverage.

3. How Billing Differs Between In-Network and Out-of-Network

In-Network:

• Fees are based on the insurance company’s contracted rates (also called “allowed amounts”)

• You’re required to write off the difference between your office fee and the allowed amount

• Claims are submitted directly to the insurance company by the provider

• Patients usually have lower out-of-pocket costs

• Costs and coverage are generally more predictable for both provider and patient

Out-of-Network:

• You can set your own fees without restrictions from the insurance company

• You are not required to write off any portion of your fee unless the insurance plan explicitly prohibits balance billing

• Insurance may still pay part of the cost, but typically at a lower reimbursement rate

• Patients may owe more out of pocket and may be responsible for a larger share of the cost

• Practices often still submit claims as a courtesy, but it’s not required

4.  Why This Matters for Your Practice

Whether you’re in-network, out-of-network, or a mix of both, understanding the differences affects:

• How you present treatment plans and estimates

• Your collections strategy

• The patient experience and satisfaction

Clear billing practices reduce confusion, build trust, and improve your ability to collect what you’ve earned—regardless of your network status.

5.  How I Help Practices Navigate Both

As an independent dental biller, I work with both in-network and out-of-network providers. I can help your practice:

• Understand fee schedules and write-offs

• Submit clean, accurate claims

• Educate patients about their benefits

• Follow up on insurance payments and patient balances

• Avoid common billing errors tied to network status

Whether you’re contracted with major carriers or out-of-network by design, I’ll help make sure your billing processes support your revenue and your reputation.

Conclusion:

In-network and out-of-network billing each come with their own challenges—but with the right systems and support in place, both can be effective and profitable. The key is knowing how each model works and having a strategy that fits your practice’s goals.

Need help improving your billing process? Let’s connect and talk about how I can support your practice—no matter what network status you operate under.