Reminder: ‘We accept your insurance’ does not mean ‘we are in network’

I learned this the hard way.

I had company sponsored dental insurance for years and never thought much about it. Then I left my job, went on Covered California, and bought the cheapest dental PPO plan I could find. I went from Guardian to Anthem PPO and didn’t realize my current dentist was now out of network. They did not tell me.

I got 2 fillings and ended up paying around $450. At an in-network office, I probably could have paid something like $100–$150 instead.

What really got me was what happened with my daughter. The pediatric dentist said they "accept" anthem and did not clearly tell me upfront that they were out of network for her care either. I ended up paying $357 for an exam and $630 for cavities for my 5 year old. And if you have kids, you know how hard it is to take them to a dentist in the first place, let alone switch them to another one after they have already gone through all of that.

Then two weeks later, one of the fillings fell off.

So now I was stuck in this weird situation where I had to go back to the same out of network dentist for aftercare. I was at work while my wife was dealing with the front desk woman, getting a hard time, making multiple calls, trying to get someone to take responsibility. The dentist eventually redid the filling for free, but it took way too much effort and a lot of anxiety.

And honestly, I still suspect my daughter may not have needed that filling in the first place. But I will never know.

My lesson from all this is

– If you like your dentist and you are shopping for a new insurance plan, check whether they are actually in network with that exact plan.

– And when a dentist says they “accept” your insurance, that does not mean they are in network. Always confirm that directly.

– Also, for anything expensive, get a second opinion. Ask for your X-rays and treatment plan and send them to a few other offices.

I’m from a country with national healthcare and never had to think about any of this before. Learning it this way has been brutal!