Are you in network with my insurance?
I know I say this over and over, but to know for sure you need to check with your carrier. The list is usually available on the company website; many times searchable by zip code for the nearest to your location. Providers are added and deleted frequently, so the printed version you may have isn’t necessarily up to date.
If you have a dentist that is not in your plan network, you should determine if the discount is substantial enough for you to change. A really good dentist, whom you like and trust, is sometimes hard to come by and you are the best judge of what your finances are. Some dental plans are indemnity plans and allow you to choose your own provider without any type of penalty.
Some PPO (preferred provider organizations) plans pay based on UCR (usual, customary and reasonable fees) but know that these fees are based on the state of the home office of the insurance company. A cleaning in Kansas, for example, is most likely less than the cost of the one in Nevada. Other PPO plans are paid on MAC fees (maximum allowable charge for the plan).
If your dentist is not a part of your plan, you are responsible for the difference between what the office charges and what your insurance pays. A word of caution: there are some PPOs that will pay no benefits if you use a doctor outside the plan. Others pay the patient, therefore the doctor’s office will ask for direct payment from you at the time of service. Your dental front office staff can assist you in finding the information, but the ultimate responsibility is yours.