Your dentist left your insurance network mid-treatment. Now what?

Finding out that your dental provider has left your insurance network can feel like a problem you did nothing to cause. Your plan may still be active, but the network change can affect how much you pay and where you receive care. 

What you will learn in this article: 

• Your insurance is still active. The provider-insurer contract changed, not your plan. 

• You may have a short window to finish treatment at in-network rates, called a continuity-of-care period. 

• You can request your records and X-rays quickly, and a new dental provider can pick up where your old one left off. 

• Switching sooner is usually better. The longer you wait, the more you may pay out of pocket. 

Start by calling your insurer. Ask how the network change affects your current treatment, costs and benefits. If you need to find a new dental provider, you can schedule an appointment with an Aspen Dental provider to review your care and discuss your options. 

Why is this different from losing your insurance? 

When your dental plan ends, you lose coverage. When a dental provider leaves your network, your plan may still be active. What changes is how your insurer handles care from that office. 

Care received after the dental provider’s network exit date may be processed under your plan’s out-of-network rules. Your coverage and costs will depend on the terms of your plan. 

Call your insurer to confirm: 

• Whether your plan is still active 

• The date your dental provider left the network 

• How claims from that office will be processed 

• Whether your deductible or annual maximum will be affected 

• What you may have to pay if you stay with that dental provider 

How do you confirm the date and whether a grace period applies? 

What is a continuity-of-care period? 

Ask your insurer whether your plan has a rule called continuity of care. Depending on the plan, this may allow an eligible patient to finish certain active treatment with a dental provider who has left the network. 

This option is not available under every plan. The allowed time, qualifying treatment and payment rules can also vary. Call your insurer and ask: 

• What date did my dental provider leave the network? 

• Does my plan offer continuity of care? 

• Does my current treatment qualify? 

• How long would the temporary coverage last? 

• What would I have to pay? 

Ask for the answers in writing when possible. 

What if no continuity-of-care period applies? 

If your plan does not offer this option, ask how care from your current dental provider will be covered after the network exit date. 

Request a written cost estimate before receiving more treatment. Compare that amount with the estimated cost of switching to an in-network dental provider. 

How do you find a new in-network dental provider quickly? 

Log into your insurer's website and use the provider directory. Search by zip code and filter for accepting new patients. If the directory feels outdated, call the insurer directly. Ask them to confirm in real time which offices near you are in-network and taking new patients. You can also use Aspen Dental's dentist finder to see nearby offices while you sort out your network status. 

When you call a new office, tell them upfront that you're mid-treatment. Give them the name of your current dental provider and a brief description of where your care stands. A good office will ask for your records before your first visit so the dental provider can review them in advance. 

How do you get your records transferred? 

Your current dental office keeps the original record, but you generally have the right to obtain copies. According to the American Dental Association (ADA), a dental provider must honor a patient’s request for dental records within the time required by federal and state law. A covered dental practice may also have to provide copies even when the patient has an unpaid balance.¹ 

Contact your current dental provider’s office and ask how to submit a signed records-release request. Ask for copies of everything related to your current treatment. 

A review published in the Journal of Forensic Dental Sciences explains that a dental record may include written notes, X-rays, study models, referral letters, clinical photographs and laboratory information.² 

Ask specifically for: 

• Recent X-rays, including any taken for your current treatment 

• Treatment notes from your recent visits 

• Relevant laboratory orders, impressions or models 

• Referral letters or reports 

• A summary of completed and planned treatment 

Complete and accurate records can help a new dental provider understand the care you have received and decide what should happen next. The ADA notes that a dental practice covered by HIPAA may charge a reasonable, cost-based copying fee. State law may require a lower fee, so ask about the cost before requesting your copies.¹ 

Should you finish out-of-network or switch now? 

When finishing out-of-network may make sense 

Staying with your current dental provider may be worth considering if you are close to finishing treatment and the remaining cost is manageable. 

Before deciding, ask your dental provider for a written estimate. Then ask your insurer how much, if anything, the plan will pay. Do not assume your previous in-network price will continue. 

When switching sooner may make sense 

Switching may make sense if your treatment has several steps left or staying with your current dental provider would cost much more. 

A new dental provider will need to review your mouth, records and X-rays before deciding how to continue. The dental provider may follow the existing plan or recommend changes based on the examination. 

Bring your records, X-rays and any temporary dental work or appliances to your appointment. Your insurer’s member-services team can also help you compare your in-network and out-of-network options. 

If you’re deciding whether to stay out of network or switch, compare the remaining costs and treatment steps before making a decision. Your dental provider can review your records and X-rays and explain how your care could continue if you choose to switch. 

Your dental provider left your insurance network mid-treatment. Now what? FAQs 

Still have questions about changing dental providers mid-treatment? These answers cover a few common concerns. 

Will the new dental provider redo work that's already been done? 

Not automatically. A new dental provider will review your records and X-rays. If the existing work is sound, treatment continues from that point. 

What if my treatment involves a specialist, like an oral surgeon or periodontist? 

Ask your general dental provider to coordinate directly with the specialist's office. Both providers should review your transferred records together so treatment steps don't get repeated or fall out of sequence. 

What if there's no in-network dental provider near me? 

Tell your insurer. Some plans have provisions for areas with limited in-network access. Ask what options they offer when the directory is thin in your area. 

What if my new in-network dental provider doesn't accept my current treatment plan? 

A new dental provider may want to do their own exam before continuing. That's normal. Bring all your records and X-rays. In most cases, a new provider can pick up an existing plan rather than starting from scratch, especially if the records are complete. 

Will switching dental providers mid-treatment affect my annual insurance maximum? 

No. Your annual maximum is tied to your plan, not your provider. Any benefits already used at your old dental provider count toward the same annual limit. Ask your insurer for a current benefits summary so you know exactly what remains. 

Sources 

¹ American Dental Association: “Copying and/or Transferring Records.” https://www.ada.org/resources/practice/practice-management/copying-transferring-records 

² National Institutes of Health, PubMed Central, Journal of Forensic Dental Sciences: “Dental records: An overview.” https://pmc.ncbi.nlm.nih.gov/articles/PMC3009547/