Dental Insurance Explained: Watch a video from Dr. Courtney Lavigne as she explains how Courtney Lavigne Dentistry handles dental insurance.

Our office is considered an out-of-network provider happily accepting most insurance plans. Every single reason that we operate like this is in the best interest of our patients.

What is the difference between an in-network provider and an out-of-network provider?
An in-network provider has signed a contract with your insurance company that says they will do dentistry on you for the fees chosen by the insurance company, and in accordance with the rules they set forth. An out-of-network provider can accept your insurance and process the paperwork for you, but they have not signed a contract with the insurance provider.  

Does my insurance company let me see an out-of-network provider?
Almost all major insurance companies allow you to choose your dentist, whether they are in-network or out-of-network. Please call our office with your insurance plan information for a more specific answer on this.

You accept my insurance but aren’t in-network, what does that mean?
We accept your insurance and will gladly process all of the insurance paperwork for you.  Your insurance provider will submit payment directly to our office, and you won’t have to act as the middle-man. We are not a fee-for-service office where you are responsible for filing all of your own insurance paperwork. Because we are out-of-network, you may occasionally have increased co-pays for services in our office.

For example, if you were to receive a service that costs $100 in our office, but your insurance company’s decided fee is $90, and they cover 50% of the procedure, they will pay an in-network dentist $45, and you pay your in-network dentist $45. If you saw us for the procedure, the insurance company would pay us $45, but because our fee is $10 higher than the insurance companies established fee, your responsibility would be $55.  

There are so many options for dental materials it would make your head spin. We are using the top-of-the-line materials for the longest-lasting dentistry possible. Dr. Lavigne travels all over the country taking over 150 hours of continuing education each year. She’s a perfectionist with the “do it once, do it right” mentality. If her name is going on the work in your mouth, she makes sure it’s the best it can be. For the procedures where you may have a slightly increased copay, that money is being invested in yourself through higher quality, it’s not falling in our pockets. 

Why aren’t we in-network with any insurance companies?
When you are in-network with an insurance company, it means you have signed a contract with that company to accept the fees they dictate as well as the procedures they cover. Basically, you perform your treatment in accordance with their rules. We feel strongly that this puts you, the patient, at a disadvantage.  

If we were participating with insurance companies, we would not be able to offer the amount of options to our patients that we feel they deserve. Let us walk you through an example. 

If you are a participating dentist with an insurance company, you accept one flat-fee for porcelain crowns. If you look at our website at Brittney’s case, you’ll see a porcelain restoration that is indistinguishable from the rest of her teeth because of the high-quality laboratory work completed by our master ceramist, Marius. If a patient needs a single tooth crown, and we accept a flat fee dictated by an insurance company, we can’t afford to have a master ceramist complete the work. Not only would the quality of materials be lower, but the final result would not match the rest of her teeth nearly as well. To mimic the staining and unique characterizations in her teeth onto that one porcelain restoration, it takes our ceramist an increased amount of time and increased number of materials.

If you look at Jason’s case on our website, you’ll see his before crowns on the front two teeth, and then our new crowns. That’s a good example of the difference in quality you can receive from a lab.

That doesn’t mean that you’ll always have to pay a lot more for us to work on your teeth. It means that we have the freedom to assess your needs and offer you the best quality and more options for your mouth. The costs of dentistry in our office for our routine procedures like X-rays, cleanings, exams, fillings, and most crowns are reasonable and customary for the town of Wayland, and often will be covered nearly the same whether you see an in-network dentist or us. By not having our hands tied by insurance companies, we can make decisions on treatment with our patients input that are the best overall for their mouths. 

That being said, we are sensitive to the costs of dentistry and will do everything we can to maximize your insurance utilization by filing all of the necessary paperwork. We will also take the time to look at your specific plan and discuss the coverage with you prior to initiating treatment. If it is important for you to stay within the boundaries of your coverage, we will make every effort to do that. But at least that’s your choice.

If anything is still unclear, or if you have any lingering questions, please don’t hesitate to call our office and speak with us directly. This is a confusing area, and we’re here to help.