Navigating dental insurance can be confusing and even frustrating at times. At Prairie Rose, we believe that informed patients are empowered patients, and we want to help you feel confident when it comes to understanding how your dental benefits work and how they affect your care.
Below, we’ll walk you through the basics of dental insurance, explain the difference between in-network and out-of-network providers, and share why sometimes going out-of-network can ensure the best experience and care outcomes.
In-Network vs. Out-of-Network: What’s the Difference?
Most dental insurance plans operate within a Preferred Provider Organization (PPO) model. This means your insurance company has contracts with certain dentists who agree to set fees for specific procedures—these dentists are “in-network.”
- In-Network: Dentists agree to your insurance carrier’s contracted rates. This may reduce your out-of-pocket cost for certain services.
- Out-of-Network: Dentists do not have a contract with the insurance provider, but you can still receive care and use your benefits. Many patients are surprised to learn that their insurance still covers a significant portion of out-of-network care—sometimes nearly the same as in-network, depending on the plan.
At Prairie Rose, we can submit claims to most insurance carriers, in- or out-of-network. The important thing to know is: your insurance carrier—not our office—determines how much is covered and what portion you’re responsible for absorbing.
Out-of-Network, Not Out of Options: Understanding the Full Picture
While in-network coverage can offer cost savings on paper, that’s not always the full picture. Here are a few reasons why many patients choose to receive care from providers like Prairie Rose Family Dentists:
Continuity of Care
At Prairie Rose, we’re committed to providing every patient with the highest quality care using the best technology and treatment options, regardless of insurance network status. That said, many insurance plans—both in-network and out-of-network—place limitations on what they will reimburse for certain procedures or services. These restrictions can sometimes impact the timing, scope, or flexibility of care.
By choosing to work out-of-network with select carriers, we’re able to reduce the administrative delays and inconsistencies that can come with those limitations. This allows our team to focus more fully on what matters most: delivering consistent, high-quality care that puts patients first.
Greater Efficiency (and Less Stress for You)
Certain insurance carriers are known for delayed claim processing, frequent claim denials, and inconsistent payment structures. Some claims are delayed for months—or even years—creating uncertainty and stress for patients. In some cases, we’ve seen carriers overpay or underpay, leading to confusion and unexpected bills down the road.
By working with a practice that is out-of-network with difficult carriers, patients often receive:
- Clearer, more predictable billing
- Faster turnaround times
- Fewer surprise bills caused by claim errors
More Time Focused on You
When less time is spent chasing claims and correcting insurance errors, our team can spend more time where it belongs, on our patients. That means better appointment availability, more thorough consultations, and a care team that isn’t stretched thin by insurance red tape.
What You Can Expect at Prairie Rose
Whether we’re in-network with your plan or not, our commitment is the same: to provide exceptional care, clear communication, and a compassionate experience. At Prairie Rose we are committed to:
- Help you understand your insurance benefits
- Submit most claims on your behalf
- Work to maximize your coverage whenever possible
- Offer transparent estimates and guidance if your plan covers less than expected
Our ultimate goal is to ensure you get the dental care you need. Care that is modern, comfortable, and personalized—without being limited by outdated or inefficient insurance practices.
A Final Thought: It’s About Your Health, Not Just Your Insurance
While insurance is a helpful tool, it’s important to remember it’s not a healthcare plan—it’s a reimbursement plan. Your oral health affects your whole-body health, and delaying or limiting treatment due to insurance restrictions can carry long-term consequences. We’re here to answer your questions, advocate for your needs, and support you in making the best decisions for your smile and overall well-being.
Have Questions? We’re Here to Help.
Dental insurance can feel overwhelming, but you don’t have to navigate it alone. If you have questions about your benefits, a treatment estimate, or how we work with your insurance provider, our team is happy to walk you through it—step by step.
Feel free to reach out to any of our three convenient Prairie Rose offices in Bismarck-Mandan:
- North Bismarck: 701-223-8262
- South Bismarck: 701-223-1194
- Mandan: 701-751-3237
We’re here to make great dental care easier to access and understand—for you and your family.
References & Further Reading
National Association of Dental Plans – Understanding Dental Benefits
https://www.nadp.org/about-dental-plans-care/understanding-dental-benefits/
Insurance Business – Dental Insurance: Everything you need to know
https://www.insurancebusinessmag.com/us/guides/dental-insurance-everything-you-need-to-know-431204.aspx
Investopedia – How Does Dental Insurance Work?
https://www.investopedia.com/articles/personal-finance/111715/how-does-dental-insurance-work.asp