For some insurance companies it does not make a difference if our office is in or out of network, but for other companies going out of network does make a difference. The difference is the allowable fee of the insurance company. The allowable fee refers to the amount the policy pays for a specific treatment.
Insurance companies or employers may tell patients they have 100% coverage for preventative care: That means 100% of the insurance company’s allowable fee. For example (if we are out of network): If our fee for a procedure is $100, and the allowable fee of a policy is $120, the insurance company will pay $100 and the patient does not owe any co-pay. However if our fee for a procedure is $100 and the allowable fee of a policy is $85, the insurance will pay $85 and the patient will have a co-pay of $15 due to us.