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"We're not contracted with any insurance plans." If you've ever heard this phrase when calling a dental office, you might have immediately hung up, assuming your insurance wouldn't work there at all. You're not alone—this misunderstanding causes many patients to miss out on exceptional dental care simply because they don't understand what 'non-contracted' actually means.
The reality is far different from what most people assume. At Tanglewood Dental Associates, we see firsthand how insurance reimbursements have declined dramatically—sometimes paying as little as $37 for a cleaning that costs more than that amount just in staff wages. Yet we also witness patients returning to us after trying in-network providers, seeking the quality care they couldn't find elsewhere.
Understanding the difference between contracted and non-contracted dental providers isn't just about insurance jargon—it's about making informed decisions for your oral health. In this guide, we'll demystify what "non-contracted" means, explain how you can still use your insurance benefits, explore the quality implications, and help you understand why many top dental practices choose this model.
Let's start by clearing up the confusion around what "non-contracted" actually means for you as a patient.
Think of dental insurance contracts as exclusive retail agreements. When a dentist signs a contract with an insurance company, they're essentially agreeing to accept reduced fees in exchange for being listed as a "preferred provider." It's similar to how a store might accept lower profit margins to be featured in a major retailer's catalog.
When we say Tanglewood Dental Associates is "not contracted with any carriers," we mean we haven't signed agreements that would require us to reduce our fees to predetermined amounts set by insurance companies. Instead, we maintain our standard fees and bill your insurance as a courtesy, allowing them to pay their portion while you're responsible for the remaining balance.
As Alice from our front office explains it: "We're not contracted with any carriers, but we do accept policies that pay out of network. If you have a policy that has out-of-network benefits, then we accept it and we can file it."
You might hear different terms used interchangeably:
Dr. Lawnin prefers the term "non-contracted" because it's more descriptive of the actual relationship—or lack thereof—with insurance companies. Regardless of the terminology, the practical implications remain the same: we operate independently of insurance company fee schedules.
This independence allows us to make treatment decisions based solely on your needs rather than what insurance companies are willing to cover, setting the stage for a completely different approach to dental care.
Let's address the elephant in the room: yes, choosing a non-contracted provider typically means higher out-of-pocket costs. But understanding exactly how this works can help you make informed decisions and avoid surprises.
This is where many patients get confused. Your insurance company has predetermined amounts they'll pay for specific procedures, regardless of what the dental office actually charges. Think of it like a friend who always insists on splitting restaurant bills equally, regardless of what each person ordered.
For example, if a crown costs $1,674 at our office, but your insurance company has decided they'll only pay $800 for crowns, they'll send us that $800 and you'll be responsible for the remaining $874. The key difference is that we don't have to accept that $800 as payment in full—unlike contracted providers who do.
If you have a PPO (Preferred Provider Organization) plan, you likely have out-of-network benefits. As Alice notes, "PPO stands for preferred provider organization. That means you have that option to go to any doctor of your choice, any doctor that you prefer, and you still have some coverage."
However, your out-of-network benefits might include:
The financial reality requires honest conversation. Alice shares that "most of our patients pay out of pocket" because our patient base values quality care and understands the investment involved. However, this doesn't mean insurance is worthless—it can still provide significant assistance with your dental care costs.
Consider this example: if you need $5,000 worth of dental work and your insurance pays $1,200, you're still receiving substantial help, even though you're paying more than you might at a contracted office.
Understanding these financial dynamics helps you plan appropriately and avoid the frustration of unexpected costs.
The decision to remain non-contracted isn't made lightly—it's driven by fundamental changes in how dental insurance operates and a commitment to providing exceptional care.
Here's a startling reality: dental insurance reimbursements have essentially frozen in time while everything else has increased. Alice recently processed an insurance claim that perfectly illustrates this problem: "We received an insurance check and they paid $37 for a cleaning and $20-something for an exam."
To put this in perspective, $37 doesn't even cover the hourly wage for our experienced dental hygienist, let alone the overhead costs of running a modern dental practice. As Alice observes, "It's shocking, honestly, and I've noticed it more after COVID."
This isn't just our experience. Delta Dental, one of the largest insurers, cut reimbursement rates by approximately 30% during the 2008 financial crisis and has increased them minimally since. Meanwhile, practice overhead, staff wages, technology costs, and materials have all risen substantially.
Being non-contracted allows us to make decisions based on what's best for your oral health, not what insurance companies prefer to cover. This freedom manifests in several ways:
Premium Materials: We can use the highest-quality materials available without worrying about insurance approval or reimbursement limits.
Adequate Appointment Time: We don't need to rush through appointments to see high volumes of patients to make up for reduced fees.
Fair Staff Compensation: We can hire experienced, skilled professionals and pay them competitive wages, which directly benefits the quality of your care.
Advanced Technology: We can invest in the latest equipment and techniques because we're not constrained by insurance reimbursement rates that haven't kept pace with innovation.
Alice has observed what happens when practices try to make insurance math work: "Many offices that are in network charge out for everything. They look for things to charge out." This volume-driven approach can lead to:
As Alice puts it, "We've had patients try to go in network and they return to us because the quality isn't always the best."
This patient feedback validates our approach and reinforces why we've chosen to prioritize clinical excellence over insurance participation.
The relationship between insurance networks and quality of care is complex, but our experience reveals some concerning patterns that every patient should understand.
When dental practices accept drastically reduced insurance reimbursements, they face a mathematical challenge: how do you maintain profitability while providing quality care? Unfortunately, the most common solution is increasing patient volume, which can compromise the very care you're seeking.
Alice regularly sees the results of this approach: "We get a lot of patients that come back to us. They've been diagnosed and they have these long treatment plans, and they're trying to find any and everything that they can, even if something may not really be needed."
Perhaps most telling is what Alice observes about patients seeking second opinions: "We have patients that come back and ask us to do the exam to see if that's really necessary. And there are times that some of the treatment is... they don't see the same treatment needed."
This isn't about disparaging other providers—it's about recognizing how economic pressures can influence clinical decision-making. When a practice needs to generate more revenue to offset low insurance reimbursements, there's inherent pressure to find more treatment needs.
Dr. Lawnin's reputation for honest, conservative treatment planning stems partly from our financial independence from insurance constraints. When we're not pressured to maximize insurance claims or increase volume to compensate for low fees, we can focus on what you actually need.
This conservative approach means:
Without insurance restrictions, we can use materials and techniques that provide the best long-term results, even if they cost more initially. For instance, our porcelain restorations may cost more than amalgam alternatives, but they provide superior aesthetics, durability, and biocompatibility.
This investment in quality materials and technology ultimately saves you money and provides better outcomes over time, even if the initial cost is higher.
Despite common misconceptions, using your dental insurance at a non-contracted office is straightforward—and in many cases, more convenient than you might expect.
The first step is understanding your specific benefits. Not all insurance plans are created equal, and out-of-network benefits vary significantly. When you call our office, we'll help you verify:
Alice emphasizes the importance of this step: "Because we're out of network, their insurance may not pay our full fee, but we'll file it and the difference is billed to them."
One of the biggest advantages of choosing Tanglewood Dental Associates is that we manage the insurance complexity for you. As Alice notes, "We submit, I would say, 90, probably 98, 99% of people that have insurance. We submit all of them."
Here's what this means for you:
The rare exception? Alice mentions "maybe a handful that have wanted to file their own claims," but this is uncommon and only by patient preference.
Understanding the payment timeline helps set proper expectations:
This process typically takes 2-4 weeks, and we keep you informed throughout. If insurance pays more than expected, you receive a credit or refund. If they pay less, we'll discuss the remaining balance and payment options.
Even with higher out-of-pocket costs, you can maximize your insurance value:
The key is viewing your insurance as a helpful supplement rather than comprehensive coverage—an approach that aligns with how dental insurance was originally designed.
Smart financial planning makes quality dental care accessible, even with higher out-of-pocket costs. We've developed multiple pathways to help you invest in your oral health without financial stress.
Many patients overlook these powerful tools for dental expenses. As Alice explains, "HSA is a health savings account card which they get from their employer, and they get a certain amount that they can use towards dental, medical expenses."
The key distinction between these accounts:
HSA (Health Savings Account):
FSA (Flexible Spending Account):
Both accounts work seamlessly at our office—simply present your card like a credit card for covered treatments.
We understand that even with insurance, dental investments can be substantial. Our flexible payment options include:
In-House Financing: For orthodontic treatments like Invisalign, we typically offer "half down and then the remaining balance broken up into 6 months of monthly payments," according to Alice. We keep a card on file and handle automatic payments, making the process seamless.
Extended Plans: While six months is standard, Alice notes that 'Dr. Lawnin doesn't have a problem with' longer payment periods when circumstances warrant it, especially as our new financial coordinator implements more flexible options.
Third-Party Financing: For larger cases, we work with Cherry and CareCredit. Cherry is Dr. Lawnin's preferred option because "they charge a lot less" in fees compared to CareCredit, especially for longer payment terms.
Cherry financing offers several benefits:
As Alice notes, patients "can use it right away" after approval, making it convenient for urgent treatments.
Consider this perspective: the average smartphone costs $800-1,200 and lasts 2-3 years. A crown costs $1,674 and can last 15-20 years with proper care. When viewed as a long-term investment in your health, comfort, and confidence, quality dental care often provides exceptional value.
Planning ahead makes this investment more manageable and ensures you can access the care you need when you need it.
Choosing between contracted and non-contracted dental care isn't just about insurance—it's about aligning your values, priorities, and long-term oral health goals with the right provider.
The decision ultimately comes down to what matters most to you:
If cost minimization is your primary concern, contracted providers might initially seem appealing. However, consider the total cost of ownership. Lower upfront costs can lead to higher long-term expenses if treatments need to be redone or if preventive care is inadequate.
If quality and comprehensive care are priorities, the non-contracted model often provides better value. As Alice observes, patients frequently return to us after trying contracted offices because "the quality isn't always the best."
If you value provider choice and treatment autonomy, non-contracted offices offer the freedom to make decisions based on your needs rather than insurance limitations.
When evaluating any dental provider, ask these crucial questions:
Consider your oral health as a long-term investment. Alice notes that "most of our patients pay out of pocket" because they understand the value proposition. These patients often:
Every choice involves trade-offs. With non-contracted care, you're trading higher upfront costs for:
Whatever you choose, make sure you're comfortable with both the financial commitment and the care philosophy. Alice rarely encounters payment issues because "our patients understand the investment involved" in quality dental care.
The key is finding a provider whose approach aligns with your values and whose care you can trust for years to come.
Understanding what "not contracted" means transforms a potentially confusing insurance conversation into an informed healthcare decision. We've explored how non-contracted providers operate independently of insurance fee schedules, why declining reimbursements have pushed quality-focused practices toward this model, and how you can maximize your insurance benefits while accessing superior care.
The key insight is that dental insurance was never designed to cover all your oral healthcare needs—it's a supplement that can help offset costs while you invest in your long-term oral health. When practices aren't constrained by insurance limitations, they can focus on what matters most: providing conservative, high-quality treatment based on your actual needs rather than coverage maximums.
At Tanglewood Dental Associates, we've chosen the non-contracted model because it allows us to maintain the clinical excellence our patients deserve. We handle all insurance paperwork, offer flexible payment options, and work with HSA/FSA accounts to make quality care accessible. Our patients consistently tell us they appreciate the honest treatment planning, unhurried appointments, and superior outcomes this approach provides.
Ready to experience the difference for yourself? Contact our office at 713-784-2952 or book an appointment online to discuss how your specific insurance plan works with our practice. We'll provide a clear explanation of your benefits, estimated costs, and available payment options—because making informed decisions about your oral health starts with understanding all your options.
Your smile deserves care that's driven by excellence, not insurance limitations.
Clear, honest answers to the dental questions you’ve been wondering about, because understanding your care shouldn’t be complicated.
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